Chronic otitis media cholesteatoma’ and ‘mastoiditis’ are related to infections and complications in the middle ear.
The starting point of any treatment should be a detailed clinical examination by a doctor or specialist. The patient’s history and examination will lead to a hearing test, Tympanometry(measuring the pressure in the ear) and possibly a CT or MRI scan if the disease is found to be complicated.
The aim of the treatment of ‘chronic otitis media cholesteatoma’ and ‘mastoiditis’ is to resolve the symptoms displayed and to reduce their recurrence.
Initially, simple over-the-counter painkillers such as Paracetamol and Ibuprofen can be used to relieve discomfort as pain management is crucial.
The doctor may not immediately prescribe antibiotics in ear infections and may attempt using painkillers initially, however, if necessary as in the case of infants,- the patient maybe recommended a particular course of antibiotics.
Usually, a course of Amoxicillin is administered. According to the Academy of American Family Physicians, Amoxicillin is effective, safe and relatively inexpensive and has a narrow microbiologic spectrum. This is normally in the form of a liquid that needs to be orally taken.
If in some cases, there is a hole in the eardrum- antibiotic liquid eardrops maybe administered by the doctor. A dilute acidic solution such as distilled vinegar mixed with water may also be used if the symptoms are mild.
Clinical cleaning of the tissue (debriding) is carried by the specialist if deemed necessary.
When the symptoms of chronic otitis media cholesteatoma’ and ‘mastoiditis’ are more severe as observed through the Otoscopy or via Tympanometry, the specialist may recommend surgery of some form.
The primary objectives of surgery usually involve eradicating the issue and its recurrence, improving and preserving the patients hearing and sometimes, remodelling the middle ear and mastoid bones to help if there is a protracted problem.
The New York Times ‘Health Guide’ notes that the surgeries may include the following:
Prognosis & Duration
The ‘National Health Service’ (NHS) based in the UK states that majority of cases of middle ear infection (Otitis Media) will clear up within 72 hours without the need for treatment.
It is noted that chronic ear infections respond well to treatment usually. If antibiotics are administered promptly and aspiration of the ear is carried out, the result is excellent. It is noted here that 90% of patients are infection-free after this treatment.
Chronic ear infections are uncomfortable and may result in hearing loss and other serious complications, but are not life threatening.
The Academy of American Family Physicians (AAFP) advises that almost all children with chronic otitis media, a positive 70 to 90% have spontaneous resolution within 7 to 14 days. This is also why antibiotics should not routinely be prescribed initially for all children.
In the case of more severe issues where surgery is carried out to remove a cholesteatoma or repair the tympanic membrane/eardrum, the healing after surgery can take several weeks. The University of Maryland Medical Centre says that in about 90% of the cases, surgery is successful in repairing the eardrum and the infection almost always goes away.
Hearing improvement maybe harder to predict and varies depending on the following:
If a hearing reconstruction was performed to correct the problem, it will take several weeks for hearing to improve.
During this time, as the ear heals, middle ear packing and fluids are being reabsorbed and scar tissues form to help stiffen the bones. In addition, the eardrum also thins out and all these factors contribute to a hearing improvement.
Routine checkups by the doctor are advised at least yearly after the healing is completely restored, and in some cases, may be required two or more times yearly to maintain optimum health.
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