What it is
Otitis media is the medical term used for an ear infection, and can be labeled as “acute,” “recurrent,” or “chronic.” Whereas acute ear infections are sudden, often resolving on their own, chronic ear infections persist and are long-lasting. The most common symptoms of an infection include drainage from the ear, ringing in the ear (tinnitus), ear pain and/or impaired hearing. Dizziness and facial weakness are other symptoms that can indicate severe or longstanding infection. An ear infection can lead to or be indicative of other problems within the ear, such as cholesteatoma, a skin cyst that develops in the middle ear.
How it is treated
The first line of treatment for an infection is usually with antibiotics, whether in an oral form or as eardrops. Eardrops are only effective with an outer ear infection or if a tympanostomy tube is in the eardrum. The infected drainage or debris may also be required to be removed if the ear is to heal completely and to assist with delivery of the medication. When warranted, a doctor might insert tympanostomy tubes to encourage fluid to drain from the middle ear and allow air to enter. This procedure is monitored, and the tubes remain for six months to a year before falling out, although some tubes remain longer and need to be surgically removed.
Surgery
Among the reasons for surgery are to repair the eardrum, remove scar tissue and/or cholesteatoma, replacement of diseased or damaged ear bone as well as alleviation of infection. The progression of the disease determines the type of surgery needed and whether the surgery needs to be staged, with a second surgery scheduled 6-12 months after the first.
Tympanostomy tubes are placed in adults or children with recurrent or chronic ear infections. This is an outpatient procedure in which the surgeon makes a tiny hole in the eardrum to suction out fluids and to insert the tubes. Medication is typically placed via ear drops at the time of tube placement.
Myringoplasty is the term for the surgical repair of the eardrum only via the ear canal.
Tympanoplasty repairs the eardrum from the undersurface and requires an incision in the ear canal or behind the ear for access. Often this involves repair or replacement of the ear bones or other work in the middle ear at the time of this operation.
Mastoidectomy refers to the removal of bone behind the ear to access disease located in the middle ear and/or mastoid bone when infection or cholesteatoma are present.
Risks
No surgery is completely without risk and the outcome depends on the extent of the disease. Even in successful surgeries and recoveries, there is a small chance (about 1%) that hearing may be damaged, leading to complete hearing loss.
The sense of taste can also be temporarily or permanently affected because the chorda tympani (taste nerve), which is located under the eardrum, can be stretched or cut during surgery.
Although it is rarely injured (less than 1%), the facial nerve also travels through the middle ear and mastoid and is always at risk with any ear surgery. This nerve is monitored throughout most ear operations and is rarely ever injured.
Other risks include tinnitus (or head noise), vertigo (or the sensation of spinning), problems with balance, or damage to the eardrum. Infection and skin cysts can also return after surgery, requiring additional procedures.
