Otitis media

Last revised by Dr Yuranga Weerakkody on 29 Nov 2021

Otitis media refers to inflammation or infection of the middle ear cavity.

The specific type of otitis media depends on various clinical findings and setting:

It is most commonly seen in children.

In acute otitis media, otalgia is the most common complaint. Other common signs and symptoms include otorrhea, hearing loss, headache, fever, and irritability. The otoscopic signs with the highest positive predictive value for acute otitis media are a bulging tympanic membrane followed by impaired mobility on pneumatic otoscopy 5. The redness of the tympanic membrane is less reliable but may be used to make the diagnosis in combination with other signs such as the presence of middle ear effusion.

In otitis media with effusion, most cases are asymptomatic. When patients are symptomatic, the most common finding is mild conductive hearing loss.

In chronic otitis media, the most common complaints are persistent otorrhea and hearing loss. Otoscopic examination demonstrates a perforated tympanic membrane.

A mixture of factors predispose to otitis media, but Eustachian tube dysfunction or obstruction 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.

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 visualized may require imaging. Exact imaging features vary depending on the form but in general includes

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
  • cholesterol granuloma 6
  • 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
  • hemotympanum
    • following trauma
    • associated with skull base fracture

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Cases and figures

  • 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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  • Case 5: with otogenic abscess
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