University of Montana
Middle ear disease and middle ear infection are two of the many ways to refer to otitis media, an inflammation of the middle ear. Despite its many names, otitis media has only one primary cause, Eustachian (auditory) tube dysfunction. There are many risk factors that may prevent proper Eustachian tube function and which may ultimately result in a conductive hearing loss (Klein, 1994). The Eustachian tube is described in our assigned text, Anatomy and Physiology for Speech, Language, and Hearing, Fourth Edition, as the communicative port which connects the nasopharynx to the middle ear (Seikel, King, & Drumright, 2010). The Eustachian tube is normally in a closed resting position in order to protect the middle ear and according to Seikel et al. (2010), “it is opened during deglutition and yawning and provides a means of aeration of the middle ear cavity” (p. 327). Proper function of the Eustachian tube is defined by its three physiological functions. These functions are listed by Ghadiali, Banks, and Swarts (2004) as, “1) protection of the middle ear from opportunistic pathogens of the nasopharynx, 2) clearance of middle ear fluids, and 3) ventilation of the middle ear to ambient pressures” (p. 649). In addition to ventilation functions, periodic opening of the auditory tube is also required for proper clearance functions (Ghadiali et al., 2004).
Eustachian tube dysfunction is simply defined by Ghadiali et al. (2004) as the “inability to open the collapsible Eustachian tube” (p. 649). The middle ear space is normally filled with air, a necessary feature for proper movement of the three ossicles. Otitis media occurs when proper functioning of the Eustachian tube is inhibited and the middle ear cavity becomes filled with fluid, restricting ossicular chain motion and resulting in a conductive hearing loss (Welling & Ukstins, 2015). The hearing loss experienced with otitis media is considered conductive because it occurs due to infection in the middle ear. A sensorineural hearing loss occurs because of damage in the inner ear and is typically permanent (Welling & Ukstins, 2015). Individuals with hearing loss due to middle ear pathology may experience significant loss in sound intensity. However, because the cochlea is unharmed, the clarity of speech should be unaffected and the hearing loss should be treatable (Welling & Ukstins, 2015).
Otitis media is commonly caused by viruses of the upper respiratory tract traveling up the Eustachian tube causing infection. The two most common forms or stages include acute otitis media and otitis media with effusion (A. Yonovitz, personal communication [Lecture notes], September 23, 2014).
Acute otitis media does not typically result in a loss of hearing, however, it does tend to have associated painful symptoms. Congestion in the ears, earache, and an elevated temperate are common (A. Yonovitz, personal communication [Lecture notes], September 23, 2014). Acute otitis media usually resolves on its own and does not require treatment with antibiotics. Otitis media with effusion, however is normally not associated with pain, but may have more serious consequences that could require surgical intervention (Welling & Ukstins, 2015). According to Welling and Ukstins (2015),
On occasion fluid will remain in the middle ear space because the Eustachian tube walls stick to each other and create a vacuum, which pulls the fluid from the skin cells lining the middle ear. This fluid is called effusion. The presence of effusion may result in a temporary loss of sound intensity (i.e., a conductive hearing loss). To remedy this situation, an otolaryngologist (ear-nose-throat surgeon) may surgically insert a tympanostomy (pressure-equalizing) tube into the eardrum. This tube helps to ventilate the middle ear space, thereby giving the dysfunctional Eustachian tube a chance to heal so that the middle ear cavity is once again