Definition

Acute suppurative otitis media is an infection distinguished by pus in the middle ear. This condition is part of the acute otitis media disease spectrum, an inflammation occurring within less than three weeks in the middle ear caused by either bacteria or viruses. This infection results in the accumulation of fluid in the affected middle ear.

The middle ear, located behind the eardrum, houses the delicate bones integral to hearing. It is the air-filled space between the eardrum and the inner ear.

Acute suppurative otitis media is more prevalent in children than in adults, with the majority of cases occurring in young children aged 6 to 24 months. The incidence decreases after the age of 5 years. Approximately 3 out of 4 children experience at least one episode of otitis media by the age of 3 years.

Causes

Bacterial and viral ear infections are the primary cause of acute suppurative otitis media. The most common bacteria involved are Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Streptococcus pyogenes. The most frequent viral culprits are the respiratory syncytial (RSV) and rhinovirus.

Ear infections often follow a flu, cold, or other respiratory infections. Bacteria or viruses can migrate to the middle ear via the eustachian tube, a tube or tract that connects the middle ear to the back of the throat. These pathogens can cause the eustachian tube to swell and block the fluid, accumulating fluid normally produced in the ear. This trapped fluid can then infect, resulting in pus production and pain.

The eustachian tube is shorter and more horizontal in children than in adults. The structural difference makes the tube more prone to blockage and fluid retention. Several factors can cause the eustachian tube to swell or become obstructed, including:

• Allergies
• Flu
• Sinus infections (affecting the sinus or hollow spaces behind the nose, cheeks, and forehead)
• Infections or enlargement of the adenoid glands (located at the back of the nose and throat)
• Exposure to cigarette smoke
• Drinking while lying down (in infants)

Risk factor

Factors contributing to the increased risk of acute suppurative otitis media include:

Age 

Infants and children aged 6 months to 2 years are particularly vulnerable to ear infections. This is due to their eustachian tubes' shorter and more horizontal structure and their still-developing immune systems.

 Family History

A familial predisposition to otitis media is noted. Additionally, children experiencing colds or respiratory tract infections are at an increased risk for developing acute suppurative otitis media.

 Allergy History

Allergies can lead to inflammation of nasal passages and upper respiratory tract, potentially causing adenoid enlargement. Enlarged adenoids can obstruct the eustachian tube, preventing proper fluid drainage from the ear and leading to fluid accumulation, pressure, pain, and possible infection.

Cleft Palate/Lip

Children with a cleft palate or cleft lip have structural differences in bones and muscles that impede normal eustachian tube function, hindering fluid drainage. Chronic illnesses or conditions compromising the immune system also increase susceptibility to infections.

Attendance of adycare

Children frequently attend daycare or playgroups have a higher incidence of colds and ear infections than those cared for at home.

 Bottle Feeding While Lying Down

Infants who drink from bottles while lying down are more prone to ear infections than those who are breastfed.

Seasonal Factors

Ear infections are more common during the fall and winter. Individuals with seasonal allergies are at greater risk during winter. Exposure to cigarette smoke or high levels of air pollution increases the risk of ear infections.

Symptoms

Infants and children may exhibit one or more of the following symptoms:

• Crying
• Irritability
• Ear tugging
• Ear pain
• Headache
• Neck pain
• Sensation of fullness in the ears
• Fever
• Vomiting
• Diarrhea
• Loss of balance
• Hearing difficulties

Diagnosis

In diagnosing acute suppurative otitis media, doctors begin by interviewing the child's parents or caregivers to gather information about the symptoms and any history of ear and respiratory tract infections. Following the interview, an otoscope, a device equipped with a magnifying glass and light, is used to examine the ear's condition.

In acute suppurative otitis media cases, the eardrum typically appears to bulge toward the external ear canal due to pus in the middle ear. Doctors can often diagnose acute suppurative otitis media based on the symptoms and findings from the otoscope exam.

Some other additional diagnostic tests that may be employed include :

Pneumatic Otoscopy

This examination allows the doctor to observe the inside of the ear and determine if there is fluid behind the eardrum. The doctor uses the pneumatic otoscope to blow air onto the eardrum gently. In a healthy ear, the eardrum moves in response to the air. If fluid is present in the middle ear, the eardrum will not move.

Tympanometry

This test measures eardrum movement by covering the ear canal and adjusting the air pressure inside the ear, causing the eardrum to move. The device then measures the eardrum's movement, indirectly indicating the pressure in the middle ear.

Acoustic Reflectometry

This technique measures the amount of sound reflected back from the eardrum, which helps determine if fluid is present in the middle ear. In healthy ears, the eardrum absorbs most sounds. However, fluid pressure in the middle ear causes more sound to be reflected by the eardrum.

Tympanocentesis

In rare cases, a doctor may recommend tympanocentesis. In this procedure, a small tube penetrates the eardrum and drains fluid from the middle ear. The collected fluid is then tested to identify the causative viruses and bacteria.

Management

Some remedies to alleviate symptoms of acute suppurative otitis media that can be taken at home include:

• Placing a warm, damp washcloth over the infected ear
• Using over-the-counter ear drops to relieve pain
• Taking over-the-counter pain relievers such as ibuprofen or paracetamol

Medical treatments for acute suppurative otitis media may involve doctor-prescribed ear drops and other analgesics for pain relief. If a bacterial infection is suspected, the doctor may also prescribe antibiotics.

In certain cases, surgical intervention such as myringotomy may be recommended. This procedure involves creating a small incision in the eardrum to evacuate pus and prevent the eardrum from rupturing due to the pressure of accumulated pus in the middle ear.

Complications

Potential complications of acute suppurative otitis media include:

• Hearing impairment
• Delayed development of speech and language in children
• Spread of infection to other areas
• Ruptured eardrum

Prevention

Preventive measures that can be taken to reduce the risk of acute suppurative otitis media in children include:

• Frequently washing hands and toys to minimize the risk of colds or other respiratory infections
• Avoiding exposure to cigarette smoke
• Get Pneumococcal and flu vaccines
• Breastfeeding instead of bottle-feeding whenever possible
• Avoiding the use of pacifiers

When to see a doctor?

Symptoms and signs of acute suppurative otitis media in children can vary and sometimes be subtle. Thus, obtaining an accurate diagnosis and prompt treatment is crucial. Consult a doctor if:

• Symptoms persist for more than a day
• Symptoms are observed in children under 6 months old
• Severe ear pain is experienced
• An infant or toddler has difficulty sleeping or becomes unusually fussy following a cold or upper respiratory infection
• There is discharge, pus, or blood coming from the ear

Looking for more information about other diseases, you can check here, yes!