Otalgia natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S[2]

Overview

Natural history, complications and prognosis depend on the disease process which is involving the ear. For most of the diseases the prognosis is good with good patient recovery.

Natural History

• Otitis media: The symptoms of disease typically develop in the first five years of life. The course of the disease is benign with most of the patients recovering without any sequelae. If the otorrhea persists for more than 6-12 weeks chronic otitis media develops.
• Otitis externa: The symptoms of disease typically develop in aquatic athletes. Disease course is benign but Chronic otitis externa develops if the disease process extends more than 6 weeks. Diabetic patients are at risk for development of Malignant otitis externa which is caused by Pseudomonas bacteria.
• Mastoiditis: The symptoms of this disease typically develop in children younger than 2 years old with the median age being 12 months.
• Cholesteatoma: The symptoms of this disease typically develop in adults. Progression of this disease causes destructive lesions in the ear and also hearing loss.

Complications

• Otitis media can be complicated by the development of:
  • Mastoiditis
  • Cholesteatoma
  • Labyrinthitis
  • Facial nerve paralysis
  • Epidural abscess
  • Lateral sinus thrombophlebitis
  • Brain abscess

• Otitis externa can be complicated by the development of:
  • Necrotizing otitis externa
  • Mastoiditis
  • Chondritis of the auricle
  • Bony erosion of the base of the skull
  • Central nervous system (CNS) infection

• Mastoiditis can be complicated by the development of:
  • Hearing loss
  • Facial nerve paralysis
  • Osteomyelitis
  • Periostitis
  • Intra cranial complications - Meningitis, Cerebral abscess, Epidural abscess, Subdural empyema
  • Labyrinthitis
  • Sigmoid sinus thrombosis
  • Abscess formation

• Cholesteatoma can be complicated by development of:
  • Erosion of the temporal bone
  • Brain dysfunction
  • Intra-cranial infections

Prognosis

• Otitis media:
  • Prognosis is excellent.
  • Intra-cranial and intra-temporal complications occur in less than 1% patients.
  • Otitis media in infants younger than 12 months predisposes to long-term speech and language problems.
  • It has also been reported to negatively affect pre-existing cognitive or language problems warranting careful follow-up and early referral.

• Otitis externa:
  • Prognosis is good. Swimmers can return to routine aquatic activities in less than a week.
  • Worse prognosis is seen in some Diabetic patients in whom it may progress to Malignant otitis externa.

• Mastoiditis:
  • Prognosis of Acute Mastoiditis is good as far as facial nerve, vestibule and intra-cranial structures are not involved. Recovery is complete from Surgical mastoiditis.

• Cholesteatoma:
  • Prognosis is good with early recognition, timely surgical intervention and use of appropriate antibiotics. 90% patients have tympanic membrane perforation.