This is inflammation of the air-filed space of the middle ear. It is a common condition affecting all age groups, though particularly more prevalent among children. This include 3 main types which are;

• Acute otitis media (AOM)
• This is characterized by rapid onset of signs and symptoms of middle ear infection and inflammation.
• Often accompanied by ear pain, fever and irritability
• Otitis media with effusion (OME)
• This is the presence of fluid within the middle ear without signs and symptoms of infection.
• Commonly follows an episode of AOM
• This fluid build in the middle ear commonly causes a conductive hearing reduction
• Chronic suppurative Otitis Media (CSOM)
• This is persistent infection and inflammation of the middle ear
• There’s a persistent drainage through a perforated ear drum

Epidemiology

These ear disorders are more common among children under 3 years of age, with approximately 80-90% of these children having experienced at least an episode by age 3. Males are more affected, with a higher incidence in children attending daycare and those exposed to secondary smoke. Focusing on CSOM, 60% of cases are in the developing world causing significant hearing loss.

Some of the risk factors include; low socioeconomic status, overcrowding, malnutrition, recurrent upper respiratory tract infections and among the immune compromised.

Pathophysiology

CSOM typically develops from the following;

• As progression from acute otitis media
• Following trauma to the ear causing rapture of the ear drum
• Persistent eustachian tube dysfunction, causing chronic impaired middle ear pressure equalization and poor drainage. This chronic stasis is prone to infection and ear drum perforation

Common organisms include both gram positives, and gram-negative organisms. Gram negative organisms include Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pnuemoniae. Gram positive organisms include Staphylococcus aeruginosa, Streptococcus pyogenes. There are also other organisms such as Anaerobes like Bacteriodes species, Peptostreptococcus, Fungus like Aspergillus, Candida occurring mostly among the immune compromised.

Clinical presentation include; persistent ear discharge, reduced hearing, usually painless apart from acute exacerbations. Other symptoms could include, vertigo and tinnitus.

Complications of this illness include intracranial manifestations like meningitis, brain abscesses, otitic hydrocephalus, lateral sinus thrombosis. Other complications are mastoiditis, facial nerve paralysis, labyrinthitis, petrositis etc.

Treatment is mainly conservative through regular ear cleaning and debridement, topical antibiotics of which quinolones are first line, systemic antibiotics are usually reserved for complicated or extensive disease. Surgery is reserved for disease refractory to treatment or cases of complications. Surgeries include mastoidectomy and tympanoplasty.

Prognosis is usually good with 60-90% having successful treatment. Hearing improvement tis variable depending on the state of the ossicles and disease extent. Recurrence is dependent on etiological factors and treatment compliance.

Prevention is through early diagnosis and treatment of acute otitis media, pneumococcal and influenza vaccination, improved sanitation, nutrition and health care access. Stop habits like ear picking, putting herbs in the ears and swimming in contaminated waters