Introduction

Ear health can be an important aspect of our lives. It can affect anyone and requires our attention to deal with. In this article, we will focus on otitis media, which is known as the middle ear infection/inflammation.¹ It is usually common in children, however it can affect adults as well.¹ Usually, otitis media occurs due to bacterial infections from different causing agents – for example, Streptococcus pyogenes.²

Although otitis media affects children more often, it can still be a case that occurs in adults and can lead to a magnitude of illnesses; for example, leaving untreated infections can lead to bacteraemia, pneumonia, and even mastoiditis.²

There are several types of otitis media in adults, and it can lead to complications such as mastoiditis.³ So, what is mastoiditis? It is a critical infection in the mastoid bone which is the most common complication following acute otitis media infection.³

Hence, to further elaborate on this topic, this article will cover the link between otitis media and mastoiditis in adults in the sections below.

Overview of otitis media in adults

Types of otitis media

Acute Otitis Media (AOM)

Acute otitis media is a common infection that occurs in children, with about half of all children would have experienced at least one ear infection by the age of 2.⁴ It is less common in adults but can still occur.¹ The acute form is characterised by a sudden onset of symptoms that correlate to an ear infection that is short term.¹ It can lead to recurrent otitis (also referred to as chronic), where the infection occurs on 3 separate occasions in the last 6 months or 4 separate occasions in the past year.¹

AOM is seen as a fluid build-up in the middle ear after infection – usually from an upper respiratory tract infection like having a common cold.^1,4 There are multiple symptoms associated with it, most commonly fever and ear pain.¹

Chronic Otitis Media (COM)

Chronic otitis media occurs as a long-term or recurring infection of the middle ear - these infections can be due to a malformation in the eustachian tube or due to a bacterial/viral infection.^5,6 A more complicated form of COM is known as otitis media with effusion; which is when COM occurs with liquid in the middle ear but without any symptoms of AOM.¹ COM is also characterised by persistent discharge from the middle ear, but it can lead to more serious complications if left untreated such as perforation of the eardrum, or conductive hearing loss.⁵

Symptoms

There are multiple symptoms associated with otitis media, including:⁶

• Fever
• Ear pain
• Hearing difficulties
• Fluid drainage from the ears
• Loss of balance
• Difficulty sleeping or staying asleep
• Unusual irritability

Risk factors

Like any other illness or infection, some people are at more risk than others. For otitis media, some risk factors associated include:^6,7

• Family history of ear infections
• Having a cold or recurrent infections
• Having a weak immune system makes people more prone to infection
• Being around someone who smokes can increase damage to the respiratory tract
• Spending time around infected individuals
• Lack of breastfeeding
• Feeding with unventilated bottles can cause negative pressure in the middle ear
• Having structural issues such as eustachian tube dysfunction

Complications of otitis media

Overview of potential complications

Once an ear infection is established, it is important to treat it properly. If left untreated, it can give rise to more serious complications. For example:⁸

• Hearing loss from fluid buildup, and damage to the ear structures
• Perforation of the eardrum which can progress to persistent drainage and hearing issues
• A condition known as cholesteatoma, which is the growth of a skin cyst behind the eardrum that leads to the erosion of the bone, facial paralysis, and hearing loss

If the illness spreads far in the body and reaches the brain it can lead to more serious health issues.⁸

Another complication that is associated with otitis media is mastoiditis which will be discussed below.

Mastoiditis

Overview

Mastoiditis is known as the inflammation of the mastoid bone that is found behind the ear; this usually occurs due to an infection.^9,10 Before the antibiotic era, acute otitis media was frequently complicated by mastoiditis, with 20% of AOM cases developed into mastoiditis. ^9,11 Although now it is a rare complication to have, it can still occur.¹²

The ear anatomy can be divided into 3 parts: outer, middle, and inner ear.¹² The middle ear cavity is continuous with the lining of mastoid air cells.¹² Additionally, the middle ear is connected to the oral cavity via the eustachian tube where fluid and air drain from the middle ear.¹² When infection, inflammation, or debris causes the tube to narrow down, it provides a good environment for pathogens to thrive.¹² Hence, this can lead to mastoiditis from the middle ear.¹²

Symptoms

There are multiple symptoms associated with mastoiditis such as¹⁰

• Pain and soreness behind the ear
• Redness behind the ear
• Swelling and tenderness behind the ear
• Ear discharge
• Headache
• Hearing loss in the ear that is infected
• Fever
• Tiredness

Link between otitis media and mastoiditis

When otitis media is left untreated, this allows the bacteria and viruses to continue to grow which can lead to complications mentioned before and this includes mastoiditis.¹² Additionally, since otitis media is more common in children than adults, the diagnosis and treatment for ear infections in adults can be delayed as symptoms are less dramatic.¹² This can lead to complications rising as treatment is not administered at the right time. Furthermore, adults who have weaker immune systems or chronic illnesses and a history of ear infections are more at risk of developing mastoiditis.¹² 

Diagnosis

Otitis media

Diagnosis of otitis media include:^6,13

• Physical examination
• Otoscopy – where an otoscope is used to check for any redness, cloudiness, bulging, or perforation of the eardrum (known as the tympanic membrane)
• Tympanometry – where the change in the ear pressure is detected for any abnormality

Mastoiditis

Diagnosis of mastoiditis include:^12,14

• Physical examination
• Blood tests to assess for the presence of infection e.g. CBC, ESR and CRP
• Ear cultures to grow the bacteria in question
• CT scan to check the extent of infection such as the presence of fluid in the middle ear and mastoid condensation

Treatment

Otitis media

Treatment of otitis media usually relies on the use of antibiotics (if it is a bacterial infection), as well as pain relief medications to alleviate the symptoms associated with the infection.¹⁵ In recurrent otitis media, patients can have myringotomy which is a tube inserted in the ear to drain fluid out.¹⁶

Mastoiditis

Treatment of mastoiditis is similar to that of otitis media. For example, if it is a bacterial infection, then treatment with antibiotics (directly injected into the vein) is commenced.¹⁰ If the antibiotics do not take effect and the infection gets worse, then drainage of fluid from the ear using a needle or making a cut behind the ear can be performed.¹⁰ Also, surgery can be a treatment option by removing part of the mastoid bone (known as mastoidectomy).¹⁰

Prevention of complications

There are multiple steps that we can take to prevent ourselves from developing otitis media and its complications:¹⁷

• Timely treatment of otitis media infections
• Having regular follow up with your healthcare provider regarding your treatment and health
• Maintaining healthy habits such as avoiding smoking
• Getting the vaccinations needed against the common bacteria or viruses that cause ear infections

Summary

Ear infections can affect everyone, but they are more likely to be seen in children. Albeit they can affect adults and cause serious complications that require treatment that can be invasive like surgery. While ear infections may go away on their own without treatment, sometimes these infections become chronic and recurrent. Usually, treatment with antibiotics for bacterial infections is efficient to treat otitis media, but in cases of delayed diagnosis and treatment, the infection might spread and affect other areas of the body such as the mastoid bone. This leads to mastoiditis which can pose a serious risk to one’s health. If these infections progress and become more severe, they can lead to hearing loss and eardrum perforation. Hence, adults who suffer from ear pain, hearing loss, and fluid drainage from the ears should consult with their healthcare provider for a proper and timely treatment to avoid complications.

FAQ

What to avoid when you have otitis media?

There are multiple things to avoid when having an ear infection and that includes not putting anything inside the ear to remove earwax (e.g. cotton buds or fingers), avoiding letting water or shampoo to get into your ear, and avoiding using antihistamines as they have no documented effect.¹⁸