The Dragonfly Story

Causes, Types and Treatment of Hearing Loss / Otitis Media

Causes of conductive hearing loss / otitis media

To understand the cause of otitis media, and how it can interfere with the transmission of sound, you first need to understand the role and function of the Eustachian tube.

The Eustachian tube allows ventilation of fresh air into the middle ear and drainage of fluids from the middle ear. If the eustachian tube becomes blocked due to a cold or flu, large adenoids or tonsils, or an allergy such as hay fever, this will reduce or stop the ventilation and drainage of the middle ear. When this happens it could lead to one of the following three types of otitis media:

  • acute otitis
  • chronic otitis (glue ear)
  • chronic suppurrative otitis media (runny ear)

Types of otitis media, symptoms and treatment

Acute otitis media

Blockages in the Eustachian tube prevent ventilation and drainage of the middle ear cavity. This can result in fluid building up behind the ear drum in the middle ear. When this happens quickly, that is over a few days, it’s known as acute otitis media.

The physical symptoms of acute OM may include:

  • high temperature;
  • discharge;
  • smelly ears, and
  • sometimes vomiting and diarrhoea.

Other symptoms may include:

  • irritability;
  • poor appetite;
  • sleeping disturbance;
  • frustration;
  • anger, and
  • pain or ear ache.

These symptoms may be confused in very young children as part of a teething problem or post immunisation fevers and as a consequence it’s very easy for OM to go undetected in infants and young children. If this happens, OM may not be diagnosed until the child is older and presents with other signs and symptoms. In some cases of acute OM, the ear drum may burst resulting in a discharge from the ear.  Usually once the ear has drained the hole will heal over.

Treatment for acute OM usually involves the use of antibiotics and in some cases may involve the use of antihistamine. If the acute OM attacks occur frequently treatment may also include surgery to cut a small hole in the ear drum and grommets inserted.  These grommets allow ventilation of the middle ear and in doing so sounds which previously used to sound distorted now sound clearer. After about four months the grommets will usually be pushed out as part of the ears normal healing process and the hole will heal over.  In some cases where a child may have repeated perforation, the hole may never heal up if the infection isn’t treated properly.

Chronic otitis media (glue ear)

When fluid in the middle ear builds up slowly over a period of two to three months, chronic otitis media occurs.  You may know this by its more common name of ‘glue ear’. As the name implies, after a period of time the fluid build up becomes thick and glue-like.

While pain is usually associated with acute OM, studies have shown that pain is not normally present with chronic OM. The main symptom of chronic OM is conductive hearing loss. While little research exists on the impact of otitis media on the physical development of the child, it’s suggested that chronic otitis media in both ears may have a significant impact on the development of the child’s growth and motor skills, particularly with tasks requiring dynamic balance.

Treatment for chronic OM may include the insertion of grommets as with acute OM. Children over four years of age can also be taught by their teachers or parents to ‘pop’ their ears several times a day, by pinching the nose and blowing gently.  This will help ventilate the middle ear by pushing air up through the Eustachian tube and allowing fluid to drain away.  ‘Popping’ the ears like this may avoid the need for surgery and the insertion of grommets.

Chronic suppurative otitis media (runny ear)

The child may suffer repeated infections which results in a large permanent hole in the ear drum. When this occurs it’s called chronic suppurative otitis media. You may know this as its more common name: ‘runny ear’. With suppurative OM the ear will usually discharge, dry up, then discharge again. Sometimes the ear will never dry up if the hole remains open for a long period of time.  With conductive hearing loss it may be necessary to surgically patch the hole. Repeated suppurative OM may also cause erosion of the bone in the middle ear and permanent hearing loss.