The basic underlying problem that causing most forms of otitis is by eustachian tube dysfunction. Most otitis occurs in patients whose eustacian tube, the tube between the nose and the middle ear ,the area behind the eardrum, its do not work properly. When air cannot get through this tube adequately to the middle ear ,the negative pressure created can "suck" fluid out of the lining of the middle ear or mastoid , filling the middle ear and mastoid air cells with fluid. A mild hearing loss usually accompanies the fluid. The hearing will loss disappears when the fluid is gone as long as there are no other causes for the hearing loss. Three kinds of otitis can result from eustachian tube dysfunction. They are serous and secretory otitis, where fluid is fills inside the middle ear and mastoid, acute otitis, where pus fills the middle ear and mastoid but its presence is by short duration, and chronic otitis, where pus fills the middle ear and mastoid and it has been present for months or years. Chronic otitis is associated with infection of the bone itself and thickening and polyp formation of the mucosal lining of the middle ear and mastoid. The highest incidence of otitis media occurs in preschool children and decreases gradually after age 6.. The highest incidence occurs poor children, children in day care, and Native Americans. Additional factors that cause or aggravate otitis include the presence of enlarged adenoid tissue, lack of proper muscle in the back of the throat , allergy, immune deficiencies , sudden change in atmospheric pressure ,like poor pressurization in an airplane dropping from a high altitude , scarring or tumors in the nasopharynx, and abnormal cell function of the mucosa of the ear and nose. Diabetes does not increase the incidence or deseseas of otitis in ear, but it can make it much more difficult to be treated.
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Serous otitis, middle ear and mastoid where fairly clear fluid fills, occurs with fairly sudden obstruction of the eustachian tube. A sudden of descent of an airplane with poor presurization or bad cold are two of the most common causes of acute serous otitis media. Usually decongestants will clear the fluid or even blood that can be sucked from the mucosa into the middle ear with of these processes. If the fluid does not clear within a few weeks or within a months, it is considered a chronic serous otitis. Older people with poorly functioning eustachian tubes commonly have recurrent serous otitis and may require temporary tube placement over many years. Hearing loss is present depend on the amount of fluid inside the ear. The hearing loss usually resolves when the fluid is cleared out of the ear , either medically or surgically..
Secretory otitis, where thicker fluid fills inside or between the middle ear and mastoid, is common in small children and is often "outgrown" by the time they reach their teens. It is the most common disease process requiring the placement of PE tubesin the ear. This thicker fluid has components that are actually been "secreted" by the mucous glands of the middle ear. There are actually tissue breakdown enzymes in this fluid, that, if left untreated, its can gradually eat away bone and cause chronic hearing loss or can damage the ear drum. Luckily, it generally takes quite a while for these enzymes to cause damage to the ear, so treating secretory otitis in children with medication for a few weeks or between a months is safe. Leaving this kind of fluid in an ear for more than several months, however, places the ear tissues including the tiny ear bones, at risk of damage or destruction by these enzymes. Not treating infections with antibiotics at all places the ear structure at even higher risk of permanent damage , destruction by the fluid..
Acute otitis media occurs when pus fills the middle ear. It is usually sudden in onset and is often associated with sudden troubling of the eustachian tube at the same time infections bacteria are present to cause the acute otitis. Without antibiotic treatment, a true bacteria acute otitis is often associated with sudden penetration of the eardrum, with inner drainage from the ear. Often the eardrum will spontaneously heal over after the infection has resolved , but a penetration can be left and damage to the middle ear and the inner ear can accompany the infection. The eardrum may be bright red or the creamy color of the fluid can sometimes be seen through the eardrum. It sometimes looks "soggy." Pain and fever may accompany an ear infection, but usually disappear rapidly if the eardrum perforates. Pain and fever are rarely present if there is a hole produce in the eardrum before the infection starts. The standard treatment of acute otitis media is oral antibiotics. Ear drops are added if the eardrum perforates. antibiotics are indicated for severe infections, if the mastoid bone is also infected, or if the facial nerve becomes paralyzed as a complication of the acute infections. Hearing loss is present but usually goes away when the infection clears..
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Chronic otitis media occurs when chronic infection fills the middle ear space and mastoid cavity. True chronic otitis media is almost always a form of chronic mastoiditis, is chronically infected along with the tissues of the middle ear space. It is important to realize that antibiotics alone usually cannot remove infection from the bone surgical removal of the infected bone is usually necessary to accomplish this. Even antibiotics do not often prevent a true bone infection, especially in the mastoid, which has its connection to the bacteria filled nose through the eustacian tube. A cholesteatoma is a common additional finding along with chronic otitis and mastoiditis. A cholesteatoma is a skin that grows back into the middle ear or mastoid from the eardrum, creating a mass of skin and debris that keeps getting larger and larger over time, destroying anything in its path. The ear bones, the inner ear, the facial nerve, the nerve that makes all the muscles of one side of your face work, and the brain next to the ear can all be damaged or destroyed by either spreading infection or cholesteatoma. These diseases must be removed fore the safety of the ear, the head, and the brain. Infection or cholesteatoma involving the inner ear, facial nerve, or the brain requires immediate attention by an ear doctor and often required immediate treatment.
Hearing loss usually followed by chronic otitis and cholesteatoma. There is usually a considered conductive hearing loss and there may be sensory neural hearing loss as well. The longer the ear is infected, the more likely it is that toxins from the infection become absorbed into the inner ear, affected sensory neural hearing loss. Sensory neural hearing loss resulting from infection is generally permanent and can rarely be reversed. Repair of the conductive hearing loss should only be attempted after the infection or cholesteatoma is controlled. Sometimes ear treatment has to be done in "stages" because of this fact..