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Otitis Media

Otitis media is an infection of the middle ear, the area behind the eardrum.

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Complications for Otitis Media

Left untreated, a middle ear infection over time can rupture the eardrum and cause drainage from the ear canal. At this stage, the infection usually has already involved the mastoid bone. The infection can then spread to involve the bones behind the eardrum, the facial nerve, the inner ear, and the brain.

Hearing loss can result from both the eardrum perforation and from infection causing erosion of the middle ear bones. The ossicles may also lose their ability to vibrate and become more fixed in the presence of chronic infection. For children, even a mild hearing loss may impair the development of speech and language skills.

Most cases of otitis media resolve with prompt administration of antibiotics. On occasion, despite prompt treatment, the infection can spread into the mastoid and cause mastoiditis. If the infection is serious, a mastoidectomy with administration of antibiotics may be required. Left untreated, the mastoiditis can lead to facial paralysis, dizziness, hearing loss, meningitis, and even a brain abscess. This condition is called chronic otitis media with granulation.Prompt treatment cannot be overemphasized. 


Granulation tissue is visualized behind the tympanic membrane (ear drum).

When the Eustachian tube is either dysfunctional or has become obstructed due to an infection, negative pressure can be generated in the middle ear. The eardrum can start to retract (sink) backwards, and the skin lining the outer part of the eardrum can grow into the middle ear. This is a condition called cholesteatoma. This nearly always requires surgical treatment.

Meningocele or Encephalocele

In very unusual circumstances, clear watery discharge can be noted after insertion of a tymapanostomy tube. This drainage can be associated with headaches and concomitant drainage from the nose. These symptoms should raise the suspicion for an encephalocele (herniated brain) or meningocele (herniated covering of the brain) into the mastoid bone. This requires surgical intervention to avoid development of meningitis.


A portion of brain has herniated through the temporal bone and dura into the middle ear. The next illustration is a zoomed-in version of the area outlined by the black box.


Silastic sheeting is placed over the defect in the temporal bone



About Dr. Prasad

Dr. Sanjay Prasad MD FACS is a board certified physician and surgeon with over thirty-two years of sub-specialty experience in Otology, Neurotology, advanced head and neck oncologic surgery, and cranial base surgery. He is chief surgeon and founder of the private practice, Metropolitan NeuroEar Group, located in the metropolitan Washington D.C. area.