The 5 types of Otitis (causes, symptoms and treatment)

Hearing is a sense that, although it is not strictly essential for our survival, it is a key element in one of the most important phenomena of our nature: communication. And it is that being able to perceive sounds not only helps us to detect possible dangers and orient ourselves in space, but also allows us to develop oral language. Listening is one of the many things that makes us who we are.

But this apparently routine process hides enormous morphological and physiological complexity. The human ear is made up of a dozen different structures that, working in a coordinated way, allow the vibrations of the waves that propagate through the air to be converted into nerve impulses where a message is encoded that, later in the brain, will be translated into the experimentation of sounds as such.

And, as always happens, a high degree of biological complexity is linked to greater susceptibility, fragility and sensitivity to damage. Hence, ear diseases are not only common, but potentially dangerous to health in this regard. Even so, of all the disorders that can affect the human ear, we will agree that otitis is, without a doubt, the best known for its high incidence.

Thus, in today's article and from the hand of the most prestigious scientific publications, we are going to inspect the clinical bases of otitis, a pathology that consists of an inflammation of different structures of the ear due to, generally, an infectious process. And, above all, we will analyze the peculiarities of the different kinds of otitis.

What is the anatomy of the human ear?

Before going in depth and analyzing otitis as such, it is very important that we put ourselves in context and understand the morphology of the ears, as this is essential to understand the different types of otitis.

In general terms, The ears are the organs capable of perceiving the sounds of the environment through vibrations on the structures that constitute them and a transformation of these vibratory signals into nerve impulses that will be transmitted to the brain for its processing and consequent experimentation of sounds.

This perception of sound and, therefore, the ability to listen and hear, is possible, then, thanks to the action of the different components of the ear, which is divided into three regions: outer ear (receives sounds), middle ear (transmits vibrations) and inner ear (transforms vibrations into nerve impulses).

The outer ear is made up of the pinna (the outermost part, popularly known as the ear, made up of skin and cartilage and with the function of acting as an antenna), the auditory canal (a 30 mm long cavity where the wax and what is it? to drive the waves to the eardrum) and the eardrum (a very thin elastic membrane that vibrates with the waves, transmitting this vibration to the middle ear).

This middle ear is composed, in turn, by the three small bones of the ear (located in the tympanic cavity, the hammer, the anvil and the stapes, which are the smallest bones in the body, they respond to the vibrations of the eardrum causing that, due to its movement, the oval window vibrates), the oval window (a membrane that marks the border between the middle and inner ear) and the Eustachian tube (a tube that “ventilates” the middle ear and that acts by balancing pressures inside it) .

Finally, the inner ear is made up of the cochlea (a spiral-shaped structure consisting of canals that rotate on themselves to amplify the vibrations that come from the oval window), the vestibule (two cavities filled with the same fluid as the cochlea but with the function of perceiving body movement), the semicircular ducts (a kind of curls filled with vital fluids to maintain balance), the organ of Corti (a structure formed by hair cells that are very sensitive to vibrations in the fluid that communicate with nerve cells, which generate nerve impulses) and the auditory nerve (the link between the inner ear and the brain, the "highway" that transmits the nerve signal for the brain to interpret information and experience sounds).

Being clear about this structure of the ear is essential. And it is precisely depending on which part of the ear the inflammation occurs that we will be facing one type or another of otitis. For this reason, we are now more than ready to dive into the topic that has brought us here today: discovering the clinical bases of the different types of otitis.

What kinds of otitis are there?

As we have said, otitis is a disorder that consists of an inflammation of the ear caused by, generally, a bacterial infection. But also as we have seen, the structure of the ear and its sensitivity depends a lot on the exact region of the ear in which we find ourselves. Hence, in Otolaryngology, it has been important to differentiate between the following types of otitis.

1. External otitis

Otitis externa is the most common form of this disease and, in fact, is the ear disease with the highest incidence worldwide. Clinically, it is defined as inflammation of the outer part of the ear. In other words, external otitis is one in which the inflammation occurs at the level of the ear canal.

The auditory canal, as we have seen, is a component of the outer ear with a diameter of about 10 mm and a length of about 30 mm that conducts sound from the outside to the eardrum. This duct is made up of sebaceous glands that produce wax, the substance that protects this outer ear from both pathogen attack and irritation, keeping the duct clean and preventing the villi that have to improve wave propagation from being seen. damaged.

Now, no mechanical or immune protection is perfect. And there are times when we can suffer both a bacterial and fungal infection (by fungi) in this ear canal, something that, due to the immune response to this microbial attack, will stimulate the inflammation that will lead to the symptoms of this type of otitis.

It is usually caused by exposure to humidity, generally by swimming in waters contaminated with these pathogens. Hence, external otitis is especially common in summer (the incidence is higher in young men) and is also known as “swimmer's ear”. The infection is usually caused by Staphylococcus aureus or by pathogenic bacteria of the genus Pseudomonas.

Symptoms consist of earache, redness, and swelling of the lymph nodes, with fever and hearing loss being two rare clinical signs. And it is that except in immunosuppressed patients at risk, external otitis usually heals on its own in little more than a week and without leaving sequelae, although the treatment usually consists of the application of ear drops with antibiotics, which cause the infection forward faster.

2. Acute otitis media

Acute otitis media consists of an inflammation of the middle ear due to a blockage of the Eustachian tube., the structure that, as we have seen, is responsible for draining the fluid from this region of the ear, preventing infections. But if, due to the effect of allergies, sinusitis, excess mucus or a cold, it becomes clogged, the risk that, as this liquid accumulates, increases the bacteria or viruses that give rise to this disorder.

It is characterized by being brief and painful. Otitis media consists of a short but very painful episode, with symptoms similar to those of external otitis but of greater intensity. In addition, by being located in areas more internal to the ear, there is a risk that the pathogens spread to other regions of the head. Hence it has to be dealt with quickly.

In the same way, this form of otitis can cause hearing problems, because in this case, due to the difficulties that the waves have to pass through the middle ear due to the accumulation of this fluid where bacteria or viruses have proliferated, there are problems in the propagation of vibrations. Treatment consists of applying antibiotic ear drops for about 10 days., although the infection begins to remit and show signs of improvement after two days.

3. Chronic otitis media

Chronic otitis media designates the pathology in which the episodes of otitis media persist and recur periodically. That is, these brief and painful attacks of inflammation of the middle ear periodically subside and reappear. This generally happens when the accumulated fluid is never properly drained or the disease resists treatment, so there are continual reinfections of it.

In addition to the acute symptoms that appear during the episodes, the real problem is that here, due to its chronic appearance, damage accumulates in the middle ear, such as hardening of the ear tissue, the appearance of cysts, unusual secretions, alterations in the bone mastoid behind the ear, etc. Therefore, hearing can be compromised in the long run.

4. Secretory otitis media

Secretory otitis media is that pathology that develops when an acute otitis media has not been completely resolved and an excess of fluid has remained in this region. It differs from the chronic in the sense that there has not been a reinfection, but there has been a symptomatology due to this persistent plugging of the Eustachian tube.

Those affected usually notice clicking sounds when swallowing and tend to have a feeling of congestion in the ear, in addition to, sometimes, a certain loss of hearing due to how the accumulated fluid is affecting the propagation of the waves. Treatment is based on administering decongestants and applying maneuvers that allow pressure to be restored in the ear. If this cannot be solved, a drain will have to be performed.

5. Barotraumatic otitis

Barotraumatic otitis is one that causes an inflammation of the middle ear caused by a sudden change in pressure. That is, otitis does not arise from any infection, but from the physiological consequences that a sudden and significant imbalance between the pressure in the tympanic cavity and the pressure of the ambient air can have in the ear. It is common to occur during scuba dives or in the ascent or descent of an airplane.