Causes of Middle ear infection
List of causes of Middle ear infection
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Middle ear infection)
that could possibly cause Middle ear infection includes:
More causes:
see full list of causes for Middle ear infection
Middle ear infection Causes: Book Excerpts
Middle ear infection as a complication of other conditions:
Other conditions that might have
Middle ear infection as a complication may,
potentially, be an underlying cause of Middle ear infection.
Our database lists the following as having
Middle ear infection as a complication of that condition:
Middle ear infection as a symptom:
Conditions listing Middle ear infection
as a symptom may also be potential underlying causes of Middle ear infection.
Our database lists the following as having
Middle ear infection as a symptom of that condition:
Medications or substances causing Middle ear infection:
The following drugs, medications, substances or toxins are some of the possible
causes of Middle ear infection as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
See full list of 6
medications causing Middle ear infection
What causes Middle ear infection?
Causes: Middle ear infection:
Usually a viral or bacterial infection spreads from the respiratory area to the ear.
Related information on causes of Middle ear infection:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Middle ear infection may be found in:
Causes of Middle ear infection: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Middle ear infection.
Otorrhea:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Otitis externa (swimmer's ear)
–Most common source of otorrhea
–Usually associated with water contamination or cotton swab abuse
–Pain with movement of pinna
–Usually secondary to Pseudomonas or
Staphylococcus infection
- Malignant otitis externa
–Also known as necrotizing external otitis and skull base osteomyelitis
–Suspect in patients with diabetes or immunosuppression who present with persistent otorrhea, ear pain, and granulation tissue in the ear canal
–Usually secondary to Pseudomonas
-
Foreign body
–Frequently a retained cotton swab
–Often occurs in toddlers
-
Otitis media (acute or chronic) with perforated tympanic membrane
- Cholesteatoma
–A skin-lined cyst of the middle ear or mastoid that occurs secondary to chronic otitis media
–In most cases there is fullness, bulging, or a white mass of the tympanic membrane (may easily be confused with ear wax)
- Mastoiditis
–Tenderness or bogginess over mastoid
- Cerebrospinal fluid otorrhea
–Clear, colorless discharge through a tympanic membrane perforation or tympanostomy tube
–Patients usually have a history of trauma or surgery, but CSF otorrhea may occasionally be spontaneous
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Otorrhea (Ear Discharge):
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Cerumen
–Often brownish color
–Rarely associated with otalgia or pruritis
- Otitis externa
–Bacterial (frequently Pseudomonas and Staphylococcus aureus) vs fungal (especially after prolonged treatment with antibiotic drops)
–Concern: Necrotizing (malignant) otitis externa (i.e., temporal bone osteomyelitis) in immunosuppressed patients, including brittle diabetics
-
Acute otitis media with tympanic membrane (TM) perforation
–Acute perforation may already have closed by the time the patient is examined
-
Chronic perforation drainage
–From water contamination (swimming, bathing) if patient is not maintaining dry ear precautions (ear plugs, occlusive head bands, shower caps, etc.)
-
Tympanostomy tube drainage
–If bloody, suspect granulation tissue surrounding the tube
–Increased incidence when not maintaining dry ear precautions is debated (as small tube lumen diameter has considerable surface tension)
-
Chronic suppurative otitis media
–Chronic middle ear and/or mastoid infection with perforated TM
-
Cholesteatoma
–“Skin cyst” (keratinizing stratified squamous epithelium) in the middle ear/mastoid
–Benign, but often very aggressively locally
erosive (mechanical and enzymatic)
–Surgical, not medical, condition
-
Perichondritis
–Spares the lobule (as there is no cartilage there)
-
Myringitis
–TM granulation or de-epithelialization
-
Foreign body
-
CSF leak
–Watery drainage
–Traumatic or congenital
–With or without perilymphatic fistula
-
Primary dermatologic condition
–Eczema, psoriasis
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Earache:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Abscess (extradural)
Severe earache accompanied by a persistent ipsilateral headache, malaise, and a recurrent mild fever characterizes an abscess, which is a serious complication of middle ear infection.
Barotrauma (acute)
Earache associated with barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn't perforated.
Cerumen impaction
Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness.
Herpes zoster oticus (Ramsay Hunt syndrome)
Herpes zoster oticus causes burning or stabbing ear pain, commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transitory, ipsilateral, facial paralysis; partial loss of taste; tongue vesicles; and nausea and vomiting.
Keratosis obturans
Mild ear pain is common with keratosis obturans, along with otorrhea and tinnitus. Inspection reveals a white glistening plug obstructing the external meatus.
Mastoiditis (acute)
Mastoiditiscauses a dull ache behind the ear accompanied by a low-grade fever (99 to 100 F [37.2 to 37.87 C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.
Ménière's disease
Ménière's disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.
Otitis externa
Earache characterizes acute and malignant otitis externa. Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by a low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104 F (40 C). Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.
Malignant otitis externa abruptly causes ear pain that's aggravated by moving the auricle or tragus. The pain is accompanied by intense itching, purulent ear discharge, a fever, parotid gland swelling, and trismus. Examination reveals a swollen external canal with exposed cartilage and temporal bone. Cranial nerve palsy may occur.
Otitis media (acute)
Otitis media is middle ear inflammation that may be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.
Severe, deep, throbbing ear pain; hearing loss; and a fever that may reach 102 F (38.9 C) characterize acute suppurative otitis media.
The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.
Chronic otitis media usually isn't painful except during exacerbations. Persistent pain and discharge from the ear suggest osteomyelitis of the skull base or cancer.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Otorrhea:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Aural polyps
Aural polyps may produce foul, purulent and, perhaps, blood-streaked discharge. If they occlude the external ear canal, the polyps may cause partial hearing loss.
Basilar skull fracture
With a basilar skull fracture, otorrhea may be clear and watery and positive for glucose, representing cerebrospinal fluid (CSF) leakage, or bloody, representing hemorrhage. Occasionally, inspection reveals blood behind the eardrum. Otorrhea may be accompanied by hearing loss, CSF or bloody rhinorrhea, periorbital ecchymosis (raccoon eyes), and mastoid ecchymosis (Battle’s sign). Cranial nerve palsies, a decreased level of consciousness, and a headache are other common findings.
Epidural abscess
In epidural abscess, profuse, creamy otorrhea is accompanied by steady, throbbing ear pain; a fever; and a temporal or temporoparietal headache on the ipsilateral side.
Myringitis (infectious)
With acute infectious myringitis, small, reddened, blood-filled blebs erupt in the external ear canal, the tympanic membrane and, occasionally, the middle ear. Spontaneous rupture of these blebs causes serosanguineous otorrhea. Other features include severe ear pain, tenderness over the mastoid process and, rarely, a fever and hearing loss.
Chronic infectious myringitis causes purulent otorrhea, pruritus, and gradual hearing loss.
Otitis externa
Acute otitis externa, commonly known as swimmer’s ear, usually causes purulent, yellow, sticky, foul-smelling otorrhea. Inspection may reveal white-green debris in the external ear canal. Associated findings include edema, erythema, pain, and itching of the auricle and external ear canal; severe tenderness with movement of the mastoid, tragus, mouth, or jaw; tenderness and swelling of surrounding nodes; and partial conductive hearing loss. The patient may also develop a low-grade fever and a headache ipsilateral to the affected ear.
Chronic otitis externa usually causes scanty, intermittent otorrhea that may be serous or purulent and possibly foul-smelling. Its primary symptom, however, is itching. Related findings include edema and slight erythema.
Life-threatening malignant otitis externa produces debris in the ear canal, which may build up against the tympanic membrane, causing severe pain that’s especially acute during manipulation of the tragus or auricle. Most common in patients with diabetes and immunosuppressed patients, this fulminant bacterial infection may also cause pruritus, tinnitus and, possibly, unilateral hearing loss.
Otitis media
With acute otitis media, rupture of the tympanic membrane produces bloody, purulent otorrhea and relieves continuous or intermittent ear pain. Typically, a conductive hearing loss worsens over several hours.
With acute suppurative otitis media, the patient may also exhibit signs and symptoms of an upper respiratory infection — a sore throat, a cough, nasal discharge, and a headache. Other features include dizziness, a fever, nausea, and vomiting.
Chronic otitis media causes intermittent, purulent, foul-smelling otorrhea commonly associated with tympanic membrane perforation. Conductive hearing loss occurs gradually and may be accompanied by pain, nausea, and vertigo.
Trauma
Bloody otorrhea may result from trauma, such as a blow to the external ear, a foreign body in the ear, or barotrauma. Usually, bleeding is minimal or moderate; it may be accompanied by partial hearing loss.
Tumor (malignant)
Squamous cell carcinoma of the external ear causes purulent otorrhea with itching; deep, boring ear pain; hearing loss; and, in late stages, facial paralysis.
In squamous cell carcinoma of the middle ear, blood-tinged otorrhea occurs early, typically accompanied by hearing loss on the affected side. Pain and facial paralysis are late features.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Otitis media:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Otitis media results from disruption of eustachian tube patency. In the suppurative form, respiratory tract infection, allergic reaction, nasotracheal intubation, or positional changes allow nasopharyngeal flora to reflux through the eustachian tube and colonize the middle ear. Suppurative otitis media usually results from bacterial infection with pneumococcus, Haemophilus influenzae (the most common cause in children younger than age 6), Moraxella catarrhalis, beta-hemolytic streptococci, staphylococci (most common cause in children age 6 or older), or gram-negative bacteria. Predisposing factors include the normally wider, shorter, more horizontal eustachian tubes and increased lymphoid tissue in children, as well as anatomic anomalies. Chronic suppurative otitis media results from inadequate treatment for acute otitis episodes or from infection by resistant strains of bacteria or, rarely, tuberculosis.
Secretory otitis media results from obstruction of the eustachian tube. This causes a buildup of negative pressure in the middle ear that promotes transudation of sterile serous fluid from blood vessels in the membrane of the middle ear. Such effusion may be secondary to eustachian tube dysfunction from viral infection or allergy. It may also follow barotrauma (pressure injury caused by the inability to equalize pressures between the environment and the middle ear), as occurs during rapid aircraft descent in a person with an upper respiratory tract infection or during rapid underwater ascent in scuba diving (barotitis media).
Chronic secretory otitis media follows persistent eustachian tube dysfunction from mechanical obstruction (adenoidal tissue overgrowth or tumors), edema (allergic rhinitis or chronic sinus infection), or inadequate treatment for acute suppurative otitis media.
Acute otitis media is common in children; its incidence rises during the winter months, paralleling the seasonal rise in nonbacterial respiratory tract infections. Chronic secretory otitis media most commonly occurs in children with tympanostomy tubes or those with a perforated tympanic membrane.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Otorrhea:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Allergy
An allergy associated with tympanic membrane perforation may cause clear or cloudy otorrhea, rhinorrhea, and itchy, watery eyes.
Aural polyps
These polyps may produce foul, purulent, and perhaps blood-streaked discharge. If they occlude the external ear canal, the polyps may cause partial hearing loss.
Basilar skull fracture
With this disorder, otorrhea may be clear and watery and positive for glucose representing cerebrospinal fluid (CSF) leakage, or bloody, representing hemorrhage. Occasionally, inspection reveals blood behind the eardrum. The otorrhea may be accompanied by hearing loss, CSF or bloody rhinorrhea, periorbital ecchymosis (raccoon eyes), and mastoid ecchymosis (Battle’s sign). Cranial nerve palsies, decreased level of consciousness, and headache are other common findings.
Dermatitis of the external ear canal
With contact dermatitis, vesicles produce clear, watery otorrhea with edema and erythema of the external ear canal.
Infectious eczematoid dermatitis causes purulent otorrhea with erythema and crusting of the external ear canal.
With seborrheic dermatitis, otorrhea consists of greasy scales and flakes. The scalp, forehead, and cheeks are also marked by pruritic, scaly lesions.
Epidural abscess
In this disorder, profuse, creamy otorrhea is accompanied by steady, throbbing ear pain; fever; and temporal or temporoparietal headache on the ipsilateral side.
Mastoiditis
This disorder causes thick, purulent, yellow otorrhea that becomes increasingly profuse. Its cardinal features include low-grade fever and dull aching and tenderness in the mastoid area. Postauricular erythema and edema may push the auricle out from the head; pressure within the edematous mastoid antrum may produce swelling and obstruction of the external ear canal, causing conductive hearing loss.
Myringitis (infectious)
With acute infectious myringitis, small, reddened, blood-filled blebs erupt in the external ear canal, the tympanic membrane, and occasionally, the middle ear. Spontaneous rupture of these blebs causes serosanguineous otorrhea. Other features include severe ear pain, tenderness over the mastoid process, and rarely, fever and hearing loss.
Chronic infectious myringitis causes purulent otorrhea, pruritus, and gradual hearing loss.
Otitis externa
Acute otitis externa, commonly known as swimmer’s ear, usually causes purulent, yellow, sticky, foul-smelling otorrhea. Inspection may reveal white-green debris in the external ear canal. Associated findings include edema, erythema, pain, and itching of the auricle and external ear canal; severe tenderness with movement of the mastoid, tragus, mouth, or jaw; tenderness and swelling of surrounding nodes; and partial conductive hearing loss. The patient may also develop a low-grade fever and a headache ipsilateral to the affected ear.
Chronic otitis externa usually causes scanty, intermittent otorrhea that may be serous or purulent and possibly foul-smelling. Its primary symptom, though, is itching. Related findings include edema and slight erythema.
Life-threatening malignant otitis externa produces debris in the ear canal, which may build up against the tympanic membrane, causing severe pain that’s especially acute during manipulation of the tragus or auricle. Most common in diabetics and immunosuppressed patients, this fulminant bacterial infection may also cause pruritus, tinnitus and, possibly, unilateral hearing loss.
Otitis media
With acute otitis media, rupture of the tympanic membrane produces bloody, purulent otorrhea and relieves continuous or intermittent ear pain. Typically, a conductive hearing loss worsens over several hours.
With acute suppurative otitis media, the patient may also exhibit signs and symptoms of upper respiratory infection—sore throat, cough, nasal discharge, and headache. Other features include dizziness, fever, nausea, and vomiting.
Chronic otitis media causes intermittent, purulent, foul-smelling otorrhea commonly associated with perforation of the tympanic membrane. Conductive hearing loss occurs gradually and may be accompanied by pain, nausea, and vertigo.
Perichondritis
In this disorder, multiple fistulas may open on the auricle or external ear canal, causing purulent otorrhea. Typically, the auricle is edematous and erythematous, with thickened skin.
Trauma
Bloody otorrhea may result from trauma, such as a blow to the external ear, a foreign body in the ear, or barotrauma. Usually, the bleeding is minimal or moderate; it may be accompanied by partial hearing loss.
Tuberculosis
Pulmonary tuberculosis may spread through the upper airway to the middle ear, causing chronic ear infection. The tympanic membrane thickens, ruptures, and produces a watery otorrhea and mild hearing loss. Cervical adenopathy may also occur.
Tumor (benign)
A benign tumor of the glomus jugulare (jugular bulb) may cause bloody otorrhea. Initially, the patient may complain of throbbing discomfort and tinnitus that resembles the sound of his heartbeat. Associated signs and symptoms include gradually progressive stuffiness in the affected ear, vertigo, conductive hearing loss and, possibly, a reddened mass behind the tympanic membrane.
Tumor (malignant)
Squamous cell carcinoma of the external ear causes purulent otorrhea with itching; deep, boring ear pain; hearing loss; and, in late stages, facial paralysis.
In squamous cell carcinoma of the middle ear, blood-tinged otorrhea occurs early, typically accompanied by hearing loss on the affected side. Pain and facial paralysis are late features.
Wegener’s granulomatosis
This rare, necrotizing granulomatous vasculitis commonly causes perforation of the tympanic membrane and serosanguineous otorrhea. The patient may report a slowly progressive hearing loss, a cough (possibly hemoptysis), wheezing, shortness of breath, pleuritic chest pain, hemorrhagic skin lesions, epistaxis, and signs of severe sinusitis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Earache [Otalgia]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Abscess (extradural)
Severe earache accompanied by a persistent ipsilateral headache, malaise, and recurrent mild fever characterizes this serious complication of middle ear infection.
Barotrauma (acute)
Earache associated with barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn’t perforated.
Cerumen impaction
Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness.
Chondrodermatitis nodularis chronica
Chondrodermatitis nodularis chronica produces small, painful, indurated areas along the auricle’s upper rim.
Ear canal obstruction by an insect
An insect lodged in the ear canal may cause severe pain and distressing noise.
Frostbite
Prolonged exposure to cold may cause burning or tingling pain in the ear, followed by numbness. The ear appears mottled and gray or white; it turns purplish blue as it’s warmed.
Furunculosis
Infected hair follicles in the outer ear canal may produce severe, localized ear pain associated with a pus-filled furuncle (boil). The pain is aggravated by jaw movement and relieved by rupture or incision of the furuncle. Pinna tenderness, swelling of the auditory meatus, partial hearing loss, and a feeling of fullness in the ear canal may also occur.
Herpes zoster oticus (Ramsay Hunt syndrome)
Herpes zoster oticus causes burning or stabbing ear pain that’s commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transient ipsilateral facial paralysis, partial loss of taste, tongue vesicles, and nausea and vomiting.
Keratosis obturans
Mild ear pain, otorrhea, and tinnitus are common in keratosis obturans. Inspection reveals a white glistening plug obstructing the external meatus.
Mastoiditis (acute)
Mastoiditis causes a dull ache behind the ear accompanied by low-grade fever (99° F to 100° F [37.2° C to 37.8° C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.
Ménière’s disease
Ménière’s disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.
Middle ear tumor
Deep, boring ear pain and facial paralysis are late signs of a malignant tumor.
Myringitis bullosa
Myringitis bullosa is a rare bacterial infection that causes sudden, severe ear pain that radiates over the mastoid and lasts for up to 48 hours. Small serous or blood-filled vesicles may dot the reddened tympanic membrane. Transient hearing loss and a serosanguineous discharge may also occur.
Otitis externa
Earache characterizes both acute and malignant otitis externa. Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104° F (40° C). Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.
Malignant otitis externa causes sudden ear pain that’s aggravated by moving the auricle or tragus. The pain is accompanied by intense itching, purulent ear discharge, fever, parotid gland swelling, and trismus. Examination reveals a swollen external canal with exposed cartilage and temporal bone. Cranial nerve palsy may occur.
Otitis media (acute)
Otitis media is a middle ear inflammation that can be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber colored, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.
Acute suppurative otitis media is characterized by severe deep, throbbing ear pain; hearing loss; and fever that may reach 102° F (38.9° C).The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.
Chronic otitis media usually isn’t painful except during exacerbations. Persistent pain and discharge from the ear suggest cancer or osteomyelitis of the skull base.
Perichondritis
Perichondritis can cause ear pain accompanied by warmth and tenderness in the outer ear and a reddened, doughlike auricle.
Petrositis
The result of acute otitis media, this infection produces deep ear pain with headache and pain behind the eye. Other findings are diplopia, loss of lateral gaze, vomiting, sensorineural hearing loss, vertigo and, possibly, nuchal rigidity.
Temporomandibular joint infection
Typically unilateral, temporomandibular joint infection produces ear pain that’s referred from the jaw joint. The pain is aggravated by pressure on the joint with jaw movement; it commonly radiates to the temporal area or the entire side of the head.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Otitis media:
Causes
(Handbook of Diseases)
Otitis media results from disruption of eustachian tube patency. (See Sites of otitis media.)
Suppurative otitis media
In the suppurative form, respiratory tract infection, allergic reaction, nasotracheal intubation, or positional changes allow nasopharyngeal flora to reflux through the eustachian tube and colonize the middle ear. Suppurative otitis media usually results from bacterial infection with pneumococci, Haemophilus influenzae (the most common cause in children younger than age 6), Moraxella catarrhalis, beta-hemolytic streptococci, staphylococci (most common cause in children age 6 or older), or gram-negative bacteria.
Predisposing factors include genetic factors, such as susceptibility to infection; the normally wider, shorter, more horizontal eustachian tubes and increased lymphoid tissue in children; and anatomic anomalies. Chronic suppurative otitis media results from inadequate treatment of acute otitis episodes or from infection by resistant strains of bacteria or, rarely, tuberculosis.
Secretory otitis media
With secretory otitis media, obstruction of the eustachian tube causes a buildup of negative pressure in the middle ear that promotes transudation of sterile serous fluid from blood vessels in the membrane of the middle ear. Such effusion may be secondary to eustachian tube dysfunction from viral infection or allergy. It may also follow barotrauma (pressure injury caused by inability to equalize pressures between the environment and the middle ear), as can occur during rapid aircraft descent in a person with an upper respiratory tract infection or during rapid underwater ascent in scuba diving (barotitis media).
Chronic secretory otitis media follows persistent eustachian tube dysfunction from mechanical obstruction (adenoidal tissue overgrowth, tumors), edema (allergic rhinitis, chronic sinus infection), or inadequate treatment of acute suppurative otitis media.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Earache:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Abscess (extradural)
Severe earache accompanied by persistent ipsilateral headache, malaise, and recurrent mild fever characterizes extradural abscess, a serious complication of middle ear infection. The patient may also experience hearing loss.
Barotrauma (acute)
Earache associated with acute barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn’t perforated.
Cerumen impaction
Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness and ringing in the ear.
Chondrodermatitis nodularis chronica
Chondrodermatitis nodularis chronica produces small, painful, indurated areas along the upper rim of the auricle. The lesion may have a central core with scaly discharge.
Frostbite
Prolonged exposure to cold may cause burning or tingling pain in the ear, followed by numbness. The ear appears mottled and gray or white; it turns purplish blue as it’s warmed.
Furunculosis
Infected hair follicles in the outer ear canal may produce severe, localized ear pain associated with a pus-filled furuncle (boil). The pain is aggravated by jaw movement and relieved by rupture or incision of the furuncle. Pinna tenderness, swelling of the auditory meatus, partial hearing loss, and a feeling of fullness in the ear canal may also occur.
Herpes zoster oticus
Also known as Ramsay Hunt syndrome, herpes zoster oticus causes burning or stabbing ear pain, commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transitory, ipsilateral, facial paralysis; partial loss of taste; tongue vesicles; and nausea and vomiting.
Mastoiditis (acute)
Acute mastoiditis causes a dull ache behind the ear accompanied by low-grade fever (99° F to 100° F [37.2° C to 37.8° C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.
Ménière’s disease
Ménière’s disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.
Middle ear tumor
Deep, boring ear pain and facial paralysis are late signs of a malignant tumor. Hearing loss and facial nerve dysfunction may accompany middle ear tumors.
Otitis externa (acute)
Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104°F [40° C]. Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.
Otitis media (acute)
Acute otitis media is a middle ear inflammation that may be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber colored, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.
Severe, deep, throbbing ear pain, hearing loss, and fever that can reach 102°F (38.9° C) characterize acute suppurative otitis media.The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.
Petrositis
The result of acute otitis media, petrositis is an infection that produces deep ear pain with headache and pain behind the eye. Other findings include diplopia, loss of lateral gaze, vomiting, sensorineural hearing loss, vertigo and, possibly, nuchal rigidity.
Temporomandibular joint infection
Typically unilateral, temporomandibular joint (TMJ) infection produces ear pain that’s referred from the jaw joint. The pain is aggravated by pressure on the joint with jaw movement; it commonly radiates to the temporal area or the entire side of the head.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Otorrhea:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Allergy
An allergy associated with tympanic membrane perforation may cause clear or cloudy otorrhea, rhinorrhea, and itchy, watery eyes. The patient may also report nasal congestion and an itchy nose and throat.
Aural polyps
Aural polyps may produce foul, purulent, and perhaps blood-streaked discharge. If they occlude the external ear canal, the polyps may cause partial hearing loss.
Basilar skull fracture
With a basilar skull fracture, otorrhea may be clear and watery and positive for glucose, representing cerebrospinal fluid (CSF) leakage, or bloody, representing hemorrhage. Occasionally, inspection reveals blood behind the eardrum. The otorrhea may be accompanied by hearing loss, CSF or bloody rhinorrhea, periorbital ecchymosis (raccoon eyes), and mastoid ecchymosis (Battle’s sign). Cranial nerve palsies, decreased level of consciousness, and headache are other common findings.
Dermatitis of the external ear canal
With contact dermatitis, vesicles produce clear, watery otorrhea with edema and erythema of the external ear canal.
Infectious eczematoid dermatitis causes purulent otorrhea with erythema and crusting of the external ear canal.
With seborrheic dermatitis, otorrhea consists of greasy scales and flakes. The scalp, forehead, and cheeks are also marked by pruritic, scaly lesions.
Mastoiditis
Mastoiditis causes thick, purulent, yellow otorrhea that becomes increasingly profuse. Its cardinal features include low-grade fever and dull aching and tenderness in the mastoid area. Postauricular erythema and edema may push the auricle out from the head; pressure within the edematous mastoid antrum may produce swelling and obstruction of the external ear canal, causing conductive hearing loss.
Myringitis (infectious)
With acute infectious myringitis, small, reddened, blood-filled blebs erupt in the external ear canal, the tympanic membrane and, occasionally, the middle ear. Spontaneous rupture of these blebs causes serosanguineous otorrhea. Other features include severe ear pain, tenderness over the mastoid process and, rarely, fever and hearing loss.
Chronic infectious myringitis causes purulent otorrhea, pruritus, and gradual hearing loss.
Otitis externa
Acute otitis externa, commonly known as swimmer’s ear, usually causes purulent, yellow, sticky, foul-smelling otorrhea. Inspection may reveal white-green debris in the external ear canal. Associated findings include edema, erythema, pain, and itching of the auricle and external ear canal; severe tenderness with movement of the mastoid, tragus, mouth, or jaw; tenderness and swelling of surrounding nodes; and partial conductive hearing loss. The patient may also develop a low-grade fever and a headache ipsilateral to the affected ear.
Chronic otitis externa usually causes scanty, intermittent otorrhea that may be serous or purulent and possibly foul-smelling. Its primary symptom, however, is itching. Related findings include edema and slight erythema.
Otitis media
With acute otitis media, rupture of the tympanic membrane produces bloody, purulent otorrhea and relieves continuous or intermittent ear pain. Typically, a conductive hearing loss worsens over several hours.
With acute suppurative otitis media, the patient may also exhibit signs and symptoms of upper respiratory infection — sore throat, cough, nasal discharge, and headache. Other features include dizziness, fever, nausea, and vomiting.
Chronic otitis media causes intermittent, purulent, foul-smelling otorrhea commonly associated with perforation of the tympanic membrane. Conductive hearing loss occurs gradually and may be accompanied by pain, nausea, and vertigo.
Trauma
Bloody otorrhea may result from trauma, such as a blow to the external ear, a foreign body in the ear, or barotrauma. Usually, the bleeding is minimal or moderate; it may be accompanied by partial hearing loss.
Tumor
A benign tumor of the glomus jugulare (jugular bulb) may cause bloody otorrhea. Initially, the patient may complain of throbbing discomfort and tinnitus that resembles the sound of his heartbeat. Associated signs and symptoms include gradually progressive stuffiness in the affected ear, vertigo, conductive hearing loss and, possibly, a reddened mass behind the tympanic membrane.
Squamous cell carcinoma of the external ear (a malignant tumor) causes purulent otorrhea with itching; deep, boring ear pain; hearing loss; and, in late stages, facial paralysis.
In squamous cell carcinoma of the middle ear, blood-tinged otorrhea occurs early, typically accompanied by hearing loss on the affected side. Pain and facial paralysis are late features.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Earache:
Principal Causes of Earache
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Externalear including external auditory canal
- Infection/inflammation
- Otitisexterna
- Cellulitis
- Furuncle or abscess
- Perichondritis of the pinna
- Cerumen impaction
- Trauma
- Foreign body
- Neoplasm
- Middle ear, eustachian tube, and mastoiddisorders
- Infection/inflammation
- Acuteand chronic otitis media
- Otitis media with effusion
- Mastoiditis
- Trauma
- Neoplasm
- Referred ear pain from cranial nerves(V, VII, IX, X) or cervical nerves (C2, C3)
- Cranialnerve V
- Cranial nerve VII
- Cranial nerve IX
- Cranial nerve X
- Cervical nerves (C2 and C3)
- Psychogenic
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Otorrhea:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Aural polyps.Aural polyps may produce foul, purulent and, perhaps, blood-streaked discharge. If they occlude the external ear canal, the polyps may cause partial hearing loss.
Basilar skull fracture.With a basilar skull fracture, otorrhea may be clear and watery and positive for glucose, representing cerebrospinal fluid (CSF) leakage, or bloody, representing hemorrhage. Occasionally, inspection reveals blood behind the eardrum. Otorrhea may be accompanied by hearing loss, CSF or bloody rhinorrhea, periorbital ecchymosis (raccoon eyes), and mastoid ecchymosis (Battle's sign). Cranial nerve palsies, decreased level of consciousness, and headache are other common findings.
Epidural abscess.With an epidural abscess, profuse, creamy otorrhea is accompanied by steady, throbbing ear pain; fever; and a temporal or temporoparietal headache on the ipsilateral side.
Myringitis (infectious).With acute infectious myringitis, small, reddened, blood-filled blebs erupt in the external ear canal, the tympanic membrane and, occasionally, the middle ear. Spontaneous rupture of these blebs causes serosanguineous otorrhea. Other features include severe ear pain, tenderness over the mastoid process and, rarely, fever and hearing loss.
Chronic infectious myringitis causes purulent otorrhea, pruritus, and gradual hearing loss.
Otitis externa.Acute otitis externa usually causes purulent, yellow, sticky, foul-smelling otorrhea. Inspection may reveal white-green debris in the external ear canal. Associated findings include edema, erythema, pain, and itching of the auricle and external ear canal; severe tenderness with movement of the mastoid, tragus, mouth, or jaw; tenderness and swelling of surrounding nodes; and partial conductive hearing loss. The patient may also develop a low-grade fever and a headache ipsilateral to the affected ear.
Chronic otitis externa usually causes scanty, intermittent otorrhea that may be serous or purulent and possibly foul-smelling. Its primary symptom, however, is itching. Related findings include edema and slight erythema.
Life-threatening malignant otitis externa produces debris in the ear canal, which may build up against the tympanic membrane, causing severe pain that's especially acute during manipulation of the tragus or auricle. Most common in patients with diabetes and immunosuppressed patients, this fulminant bacterial infection may also cause pruritus, tinnitus and, possibly, unilateral hearing loss.
Otitis media.With acute otitis media, rupture of the tympanic membrane produces bloody, purulent otorrhea and relieves continuous or intermittent ear pain. Typically, a conductive hearing loss worsens over several hours.
With acute suppurative otitis media, the patient may also exhibit signs and symptoms of an upper respiratory infection—sore throat, cough, nasal discharge, and headache. Other features include dizziness, fever, nausea, and vomiting.
Chronic otitis media causes intermittent, purulent, foul-smelling otorrhea commonly associated with tympanic membrane perforation. Conductive hearing loss occurs gradually and may be accompanied by pain, nausea, and vertigo.
Trauma.Bloody otorrhea may result from trauma, such as a blow to the external ear, a foreign body in the ear, or barotrauma. Usually, bleeding is minimal or moderate; it may be accompanied by partial hearing loss.
Tumor (malignant).Squamous cell carcinoma of the external ear causes purulent otorrhea with itching; deep, boring ear pain; hearing loss; and, in late stages, facial paralysis.
In squamous cell carcinoma of the middle ear, blood-tinged otorrhea occurs early, typically accompanied by hearing loss on the affected side. Pain and facial paralysis are late features.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Earache [Otalgia]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Abscess (extradural).Severe earache accompanied by a persistent ipsilateral headache, malaise, and a recurrent mild fever characterizes an abscess, which is a serious complication of middle ear infection.
Barotrauma (acute).Earache associated with barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn't perforated.
Cerumen impaction.Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness.
Herpes zoster oticus (Ramsay Hunt syndrome).Herpes zoster oticus causes burning or stabbing ear pain, commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transitory, ipsilateral, facial paralysis; partial loss of taste; tongue vesicles; and nausea and vomiting.
Keratosis obturans.Mild ear pain is common with keratosis obturans, along with otorrhea and tinnitus. Inspection reveals a white glistening plug obstructing the external meatus.
Mastoiditis (acute).Mastoiditis causes a dull ache behind the ear accompanied by a low-grade fever (99° to 100° F [37.2° to 37.8° C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.
Ménière's disease.Ménière's disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.
Otitis externa.An earache characterizes acute and malignant otitis externa. Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by a low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104° F (40° C). Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.
Malignant otitis externa abruptly causes ear pain that's aggravated by moving the auricle or tragus. The pain is accompanied by intense itching, purulent ear discharge, a fever, parotid gland swelling, and trismus. Examination reveals a swollen external canal with exposed cartilage and temporal bone. Cranial nerve palsy may occur.
Otitis media (acute).Otitis media is middle ear inflammation that may be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.
Severe, deep, throbbing ear pain; hearing loss; and a fever that may reach 102° F (38.9° C) characterize acute suppurative otitis media. The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.
Chronic otitis media usually isn't painful except during exacerbations. Persistent pain and discharge from the ear suggest osteomyelitis of the skull base or cancer.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Otitis Media:
Otitis Media - risk factors
(The 5-Minute Pediatric Consult)
- Exposure to environmental tobacco smoke is an independent risk factor.
- Risk increased with exposure to large numbers of children (e.g., day care). Additive factors include number of hours spent in child care, younger age at day care entry, and type of child care setting (center vs. family day care).
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
Otitis Media and Sinusitis:
Epidemiology and Etiology
(Pediatric Infectious Disease)
The most common cause of chronic ear drainage in pediatrics is chronic
suppurative otitis media (CSOM). CSOM is defined as a chronic infection of the
middle ear and mastoid associated with a nonintact tympanic membrane or a
tympanostomy tube. CSOM may develop following an episode of acute otitis media
with perforation and subsequent development of chronic drainage. CSOM may also
be caused by a chronic perforation of the tympanic membrane in which the middle
ear becomes infected by environmental organisms. The bacteria causing CSOM
often differ from those of acute otitis media; the most common organisms
involved include
Pseudomonas aeruginosa and S. aureus. Rarely, this condition can be caused by Candida species or anaerobic bacteria.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Infectious Disease, 2004
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