Acute otitis media occurs when pus and pressure build up in the middle ear. Hearing loss is present, but normally goes away when the infection clears. Acute otitis media is usually sudden in onset and is often associated with sudden obstruction of the eustachian tube at the same time infections bacteria are present. It is also associated with a perforated eardrum, sometimes with drainage from the ear. Often the eardrum will heal over after the infection clears, but the hole can remain and damage to the middle ear and/or inner ear can accompany the infection. The eardrum may be bright red, and the creamy color of the fluid can sometimes be seen through the eardrum. It sometimes looks “soggy.”

Serous otitis is where clear fluid fills the middle ear and mastoid. It occurs with sudden obstructions of the eustachian tube. Two of the most common causes are a bad cold or a sudden descent of an airplane with poor pressurization.

Secretory otitis is where somewhat thicker fluid fills the middle ear and mastoid. It is most common in small children and often outgrown by the time they reach their teens. The thick fluid has components that are secreted by the mucous glands of the middle ear. There are tissue breakdown enzymes in this fluid that can gradually eat away bone and cause chronic hearing loss/damage.

Chronic otitis media occurs when chronic infection fills the middle ear space and mastoid cavity. Most cases are almost always a form of chronic mastoiditis, where the bone of the mastoid cavity is chronically infected along with the tissues of the middle ear space.

Causes of Otitis Media
Otitis media is often caused by infection with viral, bacterial, or fungal pathogens. Viruses such as respiratory syncytial virus and those that cause the common cold may also result in otitis media by damaging the normal defenses of the epithelial cells in the upper respiratory tract.

A major risk factor for developing otitis media is eustachian tube dysfunction, which leads to the ineffective clearing of bacteria from the middle ear. Also, children under the age of seven are more prone to otitis media due to shorter eustachian tubes, which are at a more horizontal angle than in the adult ear.

Treatment Options
Many suggest the delay of antibiotics for acute bacterial otitis media for one to three days if pain is manageable by oral or topical analgesics. In chronic cases, a myringotomy is sometimes performed to insert a tympanostomy tube into the eardrum to allow air to pass through into the middle ear, and thus release any pressure buildup and help clear excess fluid within.