Introduction

Middle ear cavity means a small isolated space between tympanic membrane and inner ear. In short, otitis media means inflammation of the middle ear.

Causes of otitis media

Generally it is divided into 3 categories:

1. First and most of all, the middle ear infection occurs by way of Eustachian tube transmission. Heavy nasal blowing, or inflammation of Eustachian tube during flu can make bacteria or virus invade middle ear directly through Eustachian tube
2. If there is persistent perforation of tympanic membrane, bacteria in the external ear canal can get into middle ear through it.
3. Bacteria in the blood stream travel to the middle ear area and stay after penetrating the vascular wall barrier.

Symptoms and signs of otitis media

Severe earache, hearing impairment and fever occur during acute otitis media episodes. Purulent ear discharge, hearing loss, and vertigo and tinnitus are encountered if the patient has chronic otitis media. Once there are cholesteatoma or any other complications, the symptoms and signs vary depending upon the region of temporal bone involved.

Complications of otitis media

Acute mastoiditis, meningitis, thrombophlebitis, or even subperiosteal abscess, brain abscess, and facial nerve palsy may happen if without appropriate treatment for otitis media, in immunocompromised state, or being invaded by drug-resistant flora.

Treatment of otitis media

1. Medication: effective antibiotics should be used for more than 14 days.
2. Local treatment: for patients with discharge and crusting in the ear canal, it is necessary to remove them to keep a good drainage of middle ear discharge or pus, which is helpful for treatment of otitis media.
3. Surgical treatment: for the patients of poor response to medication and local treatment, it is necessary to eradicate the middle ear lesion and repair the tympanic membrane to prevent subsequent complications or sequlae.

Surgical procedure

With anesthesia, endaural or postauricular incision is made, and a piece of temporalis muscle fascia is harvested. After getting into the middle ear cavity, the entire space is examined and the lesion is eradicated. Then repair of perforated drum by temporalis fascia graft and reconstruction of middle ear structure is performed. After the procedure, the external canal is packed with gelfoam pledgets and the wound is compressed by mastoid dressing.

Notification after surgery

1. It is possible to have tinnitus or water-flowing sound in the operated ear because there is absorbable pledges and solution packing inside the ear.
2. Wound compression with mastoid dressing should be kept for 1 to 2 days after the operation.
3. Please inform our medical staff if the conditions below happen: vertigo, vomiting, intractable earache, and obvious oozing from the ear packing.

Notification after discharge

1. There might be some discharge in the external ear canal. Please place aseptic cottons over the orifice of external ear canal and change it with clean aseptic cottons every day.
2. Do not remove the packing in the external ear canal. Please leave it to your attending physician to remove at the clinic.
3. Water should be keep away from wound. Put a clean cotton ball over the orifice of external ear canal before taking a bath.
4. Please take oral and topical medication timely; avoid hot food and heavy exercises or not chewable food. 
5. Please come back to our clinic as soon as possible if the conditions mentioned below happen: increased amount of discharge in the ear canal, persistent earache, vertigo, vomiting, fever, erythematous change or yellowish discharge over wound, dirty water into external ear canal, facial palsy, and so on.
6. Prevent sneezing with nostril closed, nasal blowing or taking deep breath with nose.
7. Please come back to our clinics 1 week after stitches are removed.
8. After operation, air flight is allowed 3 months later only with the permission given by the doctor.
9. Repeated hearing examination is necessary 3 months later after operation.

The prognosis of otitis media

1. The turnout of otitis prognosis often has something to do with patients and family members’ understanding of the treatment plan or their treatment attitude, whether active or passive.
2. If patients and their family falsely believe that ears without painfulness feeling and discharge indicating cured otitis, leaving tympanic membrane perforated; once there is complication, it will be an irreversible sequlae.