“Why do I keep getting ear infections?” = A discussion of Chronic Otitis Media
When patients continue to suffer repeated ear infections, this is called chronic otitis media (COM).
Chronic Otitis Media (COM) is a long-term infection and inflammation of the middle ear, which is the space inside the ear drum. This condition is characterized by the persistence of ear infections, often with a perforated tympanic membrane (eardrum) and recurrent ear discharge (otorrhea), which may be intermittent or continuous. Hearing loss is also a common symptom associated with COM. The condition can affect individuals of all ages but is more prevalent in children.
There are two main forms of COM:
Chronic Suppurative Otitis Media (CSOM): This is the more common form, where there is a persistent perforation of the tympanic membrane with recurrent or persistent discharge from the ear. The discharge is usually due to a bacterial infection, and the condition is often accompanied by varying degrees of hearing loss.
Chronic Otitis Media with Effusion (OME): Also known as "glue ear," this condition involves the accumulation of non-infectious fluid in the middle ear space, leading to hearing loss. There may not be visible signs of acute infection, and the tympanic membrane is usually intact but may be retracted or show signs of negative pressure.
Causes and Risk Factors:
Eustachian Tube Dysfunction: The Eustachian tube connects the middle ear to the back of the nose and helps to equalize air pressure. Dysfunction or blockage can lead to negative pressure, fluid accumulation, and infection.
Recurrent Acute Otitis Media: Frequent episodes of acute ear infections can lead to COM.
Upper Respiratory Infections: Frequent colds, sinusitis, and allergies can contribute to Eustachian tube dysfunction and subsequent COM.
Environmental and Lifestyle Factors: Exposure to smoke, poor air quality, and high altitude can increase the risk of COM.
Complications: If left untreated, COM can lead to several complications, including:
Hearing Loss: Persistent fluid and infection can damage the structures of the middle ear, leading to temporary or permanent hearing impairment.
Cholesteatoma: A type of skin cyst that can erode middle ear structures and lead to more severe infections and complications. If left untreated, this can destroy structures of the ear and spread beyond the ear to affect the brain with problems like encephalocele, meningitis, brain abscess, etc.
Mastoiditis: Infection of the mastoid bone behind the ear.
Tympanosclerosis: Thickening or scarring of the tympanic membrane.
Intracranial Complications: Rare but serious complications include meningitis, brain abscess, and lateral sinus thrombosis.
Treatment: Treatment aims to eradicate infection, close the perforation if present, and restore hearing. Options include:
Medical Treatment: Antibiotics to treat infection, ear drops, and steroids to reduce inflammation.
Surgical Treatment: Tympanoplasty to repair the tympanic membrane, mastoidectomy to remove infection from the mastoid bone, and ossiculoplasty to repair or replace damaged bones of the middle ear.
Management of COM requires comprehensive approach which may include medical and surgical treatment as well as longterm followup. Many patients end up needing multiple surgeries. This is important especially in children where hearing loss could impact speech and language development. Early diagnosis and treatment are crucial to prevent complications and preserve hearing.