What is Suppurative Otitis Media?

J.M. Willhite

Suppurative otitis media is a form of middle ear inflammation associated with the presence of infection. Characterized by the presence of a discharge from the affected ear, suppurative otitis media generally presents as a complication of an existing or recent illness. Also known as otitis media, acute middle ear infections are commonly diagnosed in children, but may affect anyone of any age. Treatment generally involves antibiotics to eliminate the infection. Recurrent infection may necessitate myringotomy, or temporary tube placement in the affected ear, to prevent additional fluid buildup.

Ear pain may be a sign of suppurative otitis media.
Ear pain may be a sign of suppurative otitis media.

Originating from the presence of a pathogen, suppurative otitis media generally begins in the Eustachian tube with inflammation and swelling. As the viral- or bacterial-based irritation worsens, the tube constricts, creating a blockage that facilitates the pooling of fluids in the middle ear. The stagnant pooling of fluids in the inner ear offers the perfect environment for infection to thrive.

A persistent sore throat can indicate suppurative otitis media.
A persistent sore throat can indicate suppurative otitis media.

A diagnosis of suppurative otitis media is generally based on symptom presentation and a visual examination of the inner ear. Infection will usually cause the inner ear, especially the eardrum, to appear inflamed and swollen. If necessary, additional diagnostic tests may be performed to confirm a diagnosis of suppurative otitis media. Tympanometry and tympanocentesis may be conducted to further evaluate the condition of the eardrum and obtain a fluid sample for identification and analysis. Determining the responsible pathogen is often valuable in determining the right course of antibiotic treatment.

Considering most cases of suppurative otitis media are precipitated by the common cold or an upper respiratory infection, ear pain is frequently the initial, tell-tale sign of otitis media. Once infection settles in the Eustachian tube, fluids accumulate and block in air, causing an increase in pressure within the inner ear that may temporarily impair one’s hearing. The appearance of a pus-like discharge from the ear is the hallmark sign of suppurative otitis media. Other signs of infection can include persistent headache, sore throat, and malaise. Infants and small children will often seem uncharacteristically fussy, not sleep well, or constantly favor the affected ear.

Individuals with infection-based otitis media are usually placed on an antibiotic, such as penicillin. Finishing the antibiotic treatment as directed and in its entirety is essential to reducing one’s risk for recurrent infection. Additional home-care measures may also be used, including the use of an over-the-counter (OTC) analgesic medication and the application of warm compresses to alleviate discomfort.

Depending on the severity of infection, it is possible for increased pressure to cause the eardrum to rupture, or tear. In most cases, a perforated eardrum will heal independently without treatment. When a perforation fails to heal on its own, medical treatment is necessary to seal the rupture. If a perforated eardrum remains open, one’s risk for chronic suppurative otitis media (CSOM) and other complications, including hearing loss, increases significantly.

Those who demonstrate recurrent infection or fluid accumulation may undergo an outpatient procedure known as myringotomy. During the procedure, a tiny tube, called a tympanostomy tube, is positioned in the eardrum to prevent further fluid buildup. After six to eight months, the tube comes out and the eardrum heals independently.

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