Despite the advances in antibiotic treatments, ear infections can still lead to severe neurological complications such as hearing loss, facial paralysis, meningitis, and even life-threatening brain abscesses.
Historically recognized since the time of Hippocrates, the risks associated with otitis media, particularly in young children, underscore the importance of vigilance and prompt treatment.
The Persistent Threat of Ear Infections
Antibiotics have significantly reduced the risks associated with ear infections, but serious neurological complications — such as hearing loss, facial paralysis, meningitis, and brain abscesses — can still occur, according to a article in Current Neurology and Neuroscience Reports.
This report was authored by Loyola Medicine otolaryngologists Michael Hutz, MD, Dennis Moore, MD, and Andrew Hotaling, MD.
Historical and Modern Implications of Otitis Media
Otitis media, commonly known as a middle ear infection, develops when a cold, allergy, or upper respiratory infection causes pus and mucus to accumulate behind the eardrum. This buildup results in pain and swelling. In developed countries, about 90% of children experience at least one episode of otitis media before reaching school age, typically between six months and four years. Currently, secondary complications from otitis media affect approximately 1 in every 2,000 children in developed nations.
The potential dangers of otitis media were first recognized over two millennia ago. In 460 B.C., the Greek physician Hippocrates noted its severity, stating, “Acute pain of the ear with continued high fever is to be dreaded for the patient may become delirious and die.”
Advances in Treatment and Remaining Challenges
The deadliest complication of otitis media is a brain abscess, an accumulation of pus in the brain due to an infection. The most common symptoms are headache, fever, nausea, vomiting, neurologic deficits, and altered consciousness. With modern neurosurgical techniques, most brain abscesses can be suctioned or drained, followed by IV antimicrobial treatment for six to eight weeks. During the past 50 years, mortality worldwide from brain abscesses has decreased from 40 percent to 10 percent and the rate of full recovery has increased from 33 percent to 70 percent.
Other Complications Include:
Bacterial meningitis: Symptoms include severe headache, high fever, neck stiffness, irritability, altered mental status, and malaise. As the infection spreads, the patient develops more severe restlessness, delirium, and confusion. Treatment is high-dose IV antibiotics for 7 to 21 days.
Acute mastoiditis: This is an infection that affects the mastoid bone located behind the ear. It must be treated to prevent it from progressing to more serious complications. Treatments include IV antibiotics and placement of a drainage tube.
Hearing loss: Permanent hearing loss is rare, occurring in about 2 out of every 10,000 children who have otitis media.
Facial paralysis: Prior to antibiotics, this debilitating complication occurred in about 2 out of 100 cases of otitis media. Since antibiotics, the rate has dropped to 1 in 2,000 cases. It should be treated as an emergency. About 95 percent of otitis media patients who develop facial paralysis recover completely.
Impact of Antibiotics and Importance of Vigilance
“Antibiotic therapy has greatly reduced the frequency of complications of otitis media,” Drs. Hutz, Moore, and Hotaling wrote. “However, it is of vital importance to remain aware of the possible development of neurologic complication… In order to reduce morbidity, early deployment of a multidisciplinary approach with prompt imaging and laboratory studies is imperative to guide appropriate management.”
Dr. Hutz is a resident, Dr. Moore is an assistant professor and Dr. Hotaling is a professor emeritus in Loyola Medicine’s department of otolaryngology. Their paper is titled, “Neurological Complications of Acute and Chronic Otitis Media.”
Reference: “Neurological Complications of Acute and Chronic Otitis Media” by Michael J. Hutz, Dennis M. Moore and Andrew J. Hotaling, 14 February 2018, Current Neurology and Neuroscience Reports.
DOI: 10.1007/s11910-018-0817-7
Loyola Medicine is recognized for its expert, clinically integrated team for otolaryngology-head and neck surgery. The team has extensive experience in managing all aspects of ear, nose, and throat conditions, and is committed to providing the best clinical care, education, and research.
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