The Medical Consumer's Advocate

Acute otitis media and middle ear fluid in adults.

 

A young man reports that he was diagnosed with acute otitis media and an effusion. He thought that this sort of thing usually only happened to children.

A: Acute otitis media is a short term (acute) middle ear inflammation (otitis media.) It is almost always due to a bacterial infection. You are correct that this sort of infection is much more common in children than in adults, but adults do, occasionally, get acute otitis media.

The middle ear (the space behind the eardrum) is normally an air-filled space. In the early days of your infection, this space was filled with dead white blood cells and bacteria– pus, in other words. Gradually, the pus was replaced by a clear, yellow fluid; days to weeks later, the yellow fluid (the medical term is serous effusion) will be replaced by air.

You probably have a serous effusion at present; this may take 1 to 4 weeks to resolve. Occasionally, the fluid does not go away, even after several weeks. An ear, nose and throat specialist could treat this problem by making a very small cut in your ear drum, suctioning out the fluid, and placing a tiny plastic tube into the hole to help ventilate the middle ear space. The tube could be removed at a later date, or you could wait for it to fall out all by itself, 6 to 18 months after it is inserted.

The underlying cause of most middle ear infections is Eustachian tube dysfunction. The Eustachian tubes are muscular/cartilaginous tubes that extend from each middle ear space to the top of the throat (nasopharynx.) The tubes are normally closed, but can "pop" open as needed to ventilate your middle ear spaces. That’s what the tubes are for– they allow air up into the middle ear spaces.

If you had a very long, skinny finger, you could pass it down one nostril and tickle the opening of one of your Eustachian tubes. Anything that happens to drain from your nose goes down the back of your throat, right past these openings. This explains why acute otitis media is often preceded by cold, flu, or sinusitis. In each case, a nasty mix of mucus and pus drains past the Eustachian tube openings, inflaming them and thereby making it difficult for the tubes to do their job.

Rarely, Eustachian tube dysfunction is due not to inflammation (from sinusitis, allergy or cold/flu) but to obstruction from a tumor. Tumor should be suspected when the infection is recurrent, when the serous effusion fails to resolve after several weeks, or when there are large lymph nodes in the patient’s neck. Since the Eustachian tube openings are difficult to examine by standard methods, the ear, nose and throat specialist will need to examine you by passing a flexible fiberoptic scope down a nostril to view the nasopharynx. Occasionally, further studies (such as a CT scan) may be necessary.

 

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