Otitis is a prevalent condition in childhood, especially between 6 and 24 months of life. Usually progresses without complications, but inflammation of the middle ear can also be chronic.
The AOM (OMA) is a process of infectious-inflammatory type affecting connective-epithelial tissue lining box middle ear. The result is the bulging of the tympanic membrane, this fact being very characteristic of its diagnosis. There is almost always tubal and mastoid involvement. That is, it usually also affects the Eustachian tubes and the mastoid.
It is usually a prevalent reason for earache, but it is also a potential cause of hearing loss. Cold seasons such as autumn and winter are the times when there is the most significant number of cases.
It is a widespread pathology in children; up to 60% of children under one year of age suffer from it in this period, and almost all of them sometimes when they have reached 5 years of age. The earlier an otitis occurs in the child, the more likely it is to suffer from similar recurrent symptoms.
Otitis is almost always due to bacteria such as pneumococcus and Moraxella, viral infection being less common. However, in infectious processes of the respiratory tract caused by viruses, bacterial super infection can be favored. The vaccination against pneumococcus has done significantly lower the incidence of otitis by this germ in recent years.
Although it is not a painful process, in some cases, otitis can have significant consequences, and the indiscriminate use of antibiotics can make these microorganisms resistant and trigger a more complex picture.
Middle ear anatomy
The ear comprises three parts:
- The outer ear or external auditory canal
- The middle ear
- The inner ear or labyrinth
The middle ear is an air cavity made up of three interconnected parts: in the center of this system in the middle ear box, which communicates in front with the Eustachian tube and, behind, with the mastoid.
The middle ear box is shaped like an irregular, six-sided cube. The Eustachian tube connects the middle ear box with the rhino pharynx (space behind the nose). The mastoid structure is made up of a compact part and another formed by pneumatic cavities or mastoid cells, which give it the appearance of a honeycomb. Of all these air spaces, the most important is the mastoid antrum.
Causes of otitis
The causes of otitis can be general, local, infectious, or unclassified. These are the main reasons for this ear infection:
General causes of otitis
- Age: Otitis is a prevalent disease in childhood and ranks first among pediatric emergencies. It is most common between 6 and 24 months of life. In this period, they influence:
- Suction: during suction, the rhino pharynx’s lateral walls (part of the pharynx that is at the level of the nose) compress the drainage holes of the Eustachian tube. This facilitates the passage of liquid-pasty food into the tube and enables its infection. The same is true for repeated vomiting, regurgitation (food returns to the mouth), and pacifier use. On the other hand, breastfeeding seems to reduce the risk of suffering them.
- Teething: the mechanisms by which the appearance of teeth favors otitis is unknown, but the statistical relationship is unmistakable.
- Climate and environmental factors: the appearance of acute otitis media (AOM) is frequent during the cold months.
- Pools: external otitis is also frequent in summer due to excessive humidity in the ear canal after being ‘soaked’ for a long time in swimming pools or the sea. Hence it is also known as the swimmer’s ear.
Local causes of otitis
- Eustachian tube: in the young child, it is proportionally shorter, more comprehensive, and horizontal, and it is located in a lower plane than in the adult, which facilitates its contamination.
- Acute or chronic local infections exacerbated, such as:
- Tonsillitis or adenoiditis .
- Rhinosinusal infection.
- Serous mastoiditis.
- Injuries to the external auditory canal (due to the use of cotton buds, scratching).
- Malformations: cleft palate and Down syndrome are associated with a higher number of otitis.