Causes and risk factors
It is more common in children as the Eustachian tube in children is shorter, wider, and more horizontal and opens at a lower level. The infection can reach the middle ear through Eustachian tube due to various causes like anatomical obstruction by adenoids, tumors, etc.; infections like tonsillitis, sinusitis, influenza; forcible blowing of the nose; swimming; post adenoid surgery; use of feeding bottle in an infant. Infection can also enter from external ear to the middle ear due to trauma to the eardrum while cleaning the ear or slapping, which may rupture the eardrum; head injury involving fracture of temporal bone; blood borne infection. Atmospheric pressure changes (barotrauma) can also lead to ASOM. Organisms involved in causing ASOM are Streptococcus haemolyticus, Staphylococcus aureus, Haemophilus influenzae. The disease has following stages – catarrhal stage – (congestion) characterised by occlusion of Eustachian tube and congestion in middle ear. Due to lack of oxygen in middle ear cavity, retraction of tympanic membrane occurs. Exudation stage – exudates collect in the middle ear which pushes the drum laterally. Mucoid exudates eventually become purulent. Suppuration stage-pus formation in the ear creates pressure on the eardrum causing necrosis and perforation. It starts escaping into the external ear. Healing stage – resistance offered by the body and immunity clears the infection.
Clinical presentation
Generally, ASOM follows an upper respiratory tract infection. The symptoms develop according the stage of the disease. Catarrhal stage–fullness and heaviness in the ear. Patient also complains of pain in the ear. Pain is more at night, waking the patient from sleep. It is more in recumbent position. Deafness is always an accompanying symptom. Tinnitus may be present, such as bubbling sounds in the ear. Echoing of one’s self voice is experienced (autophony). Fever, malaise, weakness is seen. In exudative stage, the symptoms become more severe. Bulging of eardrum and perforation at point of pressure occurs. The spot looks like a yellow nipple. In suppurative stage, perforation occurs and pus starts flowing out. Otorrhea is seen. The discharge can range from mucoid to purulent. Healing can take place at any stage depending upon the resistance of the patient’s body.
Investigation
Medical history by the patient and Clinical examination by the ENT doctor helps in diagnosis. Test for hearing is done. Audiometry is advised. Imaging studies such as MRI of the head, CT scan may be useful. Routine hemogram is recommended. Examination of discharged pus for detection of bacteria confirms the diagnosis.
Treatment
Treatment involves antibiotics, analgesics. Nasal decongestants are prescribed. Systemic decongestants help in clearing mastoid, Eustachian tube, and middle ear cavity. Antibiotic ear drops give symptomatic relief. Following measures can help in ASOM – avoiding water entering the ear, mopping the ear discharge with cotton. In case of failure of all of the above measures, surgical intervention is required which involves myringotomy. It consists of incision in the eardrum to drain the middle ear cavity.
Other Modes of treatment
The other modes of treatment can also be effective in treatingASOM. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the Ayurvedic system of medicine, which uses herbal medicines and synthetic derivates, is also found to be effective in treating ASOM.
