Otitis media

Dr Ian Bickle and Dr Zishan Sheikh et al.

Otitis media refers to inflammation or infection of the middle ear cavity. It is commonly seen in children and is termed otomastoiditis when inflammation spreads to involve the mastoid.

Common complaints include otalgia, otorrhoea, headache, fever and systemic upset. In chronic otitis media patients can present with conductive hearing loss, tinnitus vertigo or persistent pain.

A mixture of factors predispose to otitis media, but Eustachian tube dysfunction is thought to be one of the most important factors. Congenital palate defects, host immunity and viral or bacterial infection may all be contributing factors.

Forms

Imaging is not usually required in cases of acute otitis media as the diagnosis is clinical. However, patients with chronic otitis media that present  with hearing loss in whom the tympanic membrane cannot be visualised may require imaging. Exact imaging features vary dependent on the form but in general includes

CT

High resolution temporal bone CT is routinely performed and may show:

  • soft tissue density in the middle ear cavity
  • thickened tympanic membrane
  • bulging tympanic membrane
  • tympanic perforation

Features seen in chronic rather than acute otitis media include:

  • air-fluid level in the middle ear (effusion)
  • bony erosion (less than 10%)
  • adjacent sclerosis and hypopneumatisation of the mastoid
MRI
  • fluid signal in the middle ear cavity and mastoid antrum.
  • cholesteatoma
    • causes disruption and erosion of the auditory ossicles
    • mass like appearance rather than dependent fluid
    • can be difficult to exclude if the middle ear cavity is diffusely opacified
  • haemotympanum
    • following trauma
    • associated with skull base fracture
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Article information

rID: 48711
System: Head & Neck
Section: Gamuts
Synonyms or Alternate Spellings:
  • Otitis media (OM)

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Cases and figures

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    Case 1: bulging tympanic membrane in otitis media
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    Case 2: adhesive chronic otitis media
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    Case 3: chronic otitis media
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    Case 4
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