Ear pain is one of the most common symptoms of acute otitis media. This condition arises from dysfunction of the Eustachian tube, which connects the middle ear to the nasopharynx and helps equalize pressure between the external environment and the middle ear. When the Eustachian tube isn’t functioning properly, negative pressure develops in the middle ear, leading to a sensation of “blocked” ears. During viral infections, swelling in the nasopharynx can impair mucosal defenses, increasing the presence of bacteria in the area. This swelling may partially or completely close the Eustachian tube, and prolonged negative pressure in the middle ear can draw bacteria into the middle ear cavity, causing inflammation and resulting in otitis media. In children, enlarged adenoids in the nasopharynx can also be a contributing factor.
Symptoms of otitis media may include:
- Ear pain
- Fever
- Ear discharge in cases of a ruptured eardrum
- Other general symptoms, such as restlessness, nausea, vomiting, loss of appetite, or diarrhea
- In the case of eardrum perforation, discharge of inflammatory fluid from the ear
Diagnosis is based on an evaluation of symptoms and a clinical examination of the ears. An exam may reveal redness of the eardrum, loss of the light reflex, and bulging of the eardrum due to inflammation. The level of inflammatory fluid behind the eardrum may also be visible.
Initial treatment focuses on pain relief and reducing swelling in the nasopharynx. This can include nasal irrigation with saline solution, inhalation therapy, and, if needed, short-term use of xylometazoline nasal spray (for children over 2 years old). Antibiotic treatment is not usually required right away. However, if symptoms do not improve within 48-72 hours, antibiotic therapy may be necessary due to the development of a bacterial infection.
