Otitis Media and Middle Ear Disease Management

Otitis media, the inflammation or infection of the middle ear, remains a prevalent condition across human and veterinary medicine, contributing to hearing impairment, pain and potential intracranial complications. In humans, paediatric populations are most affected, with Eustachian tube dysfunction, viral upper respiratory infections and bacterial biofilms playing central roles. In companion animals, chronic otitis externa often progresses to otitis media, with breed predispositions and anatomical factors—particularly in brachycephalic dogs—exacerbating severity. Clinical presentation ranges from head-shaking, otorrhoea and aural discomfort to vestibular signs and, in advanced cases, central nervous system involvement. Management begins with accurate diagnosis through otoscopic examination, video-otoscopy and imaging modalities such as computed tomography or magnetic resonance imaging to assess middle ear and bulla involvement. First-line therapy typically comprises systemic or topical antimicrobials guided by cytology and culture, anti-inflammatory measures and addressing predisposing factors like allergies. Surgical interventions are indicated when medical therapy fails or in the presence of polyps, aural masses or cholesteatoma. Procedures include myringotomy, tympanostomy tube placement, lateral bulla osteotomy and total ear canal ablation with lateral bulla osteotomy. Technological advances in endoscopic and laser-assisted techniques have improved precision, reduced morbidity and enhanced postoperative outcomes. Ongoing research into the middle ear microbiome, host immune responses and novel drug delivery systems promises more personalised and less invasive approaches, emphasising the importance of interdisciplinary collaboration for optimal patient care.

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Otitis Media and Middle Ear Disease Management publication trend

The graph below shows the total number of articles in otitis media and middle ear disease management across all publications each year (not limited to Nature Index journals).

Technical terms

Otitis media: Inflammation or infection of the middle ear cavity, often following otitis externa or Eustachian tube dysfunction.

Eustachian tube: A canal linking the middle ear to the nasopharynx, responsible for pressure equalisation and drainage.

Tympanic membrane: The eardrum, a thin membrane separating the external ear canal from the middle ear.

Myringotomy: A surgical incision in the tympanic membrane to sample or drain middle ear contents.

Tympanostomy tube: A small ventilation tube placed through the tympanic membrane to maintain aeration and prevent fluid accumulation.

Cholesteatoma: A keratinising epidermoid cyst in the middle ear that can erode bone and lead to chronic infection.

Total ear canal ablation with lateral bulla osteotomy (TECA-LBO): A combined surgical procedure removing the external ear canal and opening the tympanic bulla to eradicate disease.

Video-otoscopy: Endoscopic visualisation of the ear canal and tympanic membrane, facilitating diagnosis and guided interventions.

Microbiota: The community of microorganisms inhabiting a defined environment, such as the external canal or middle ear.

References

1. Influence of extreme brachycephalic conformation on perioperative complications associated with total ear canal ablation and lateral bulla osteotomy in 242 dogs (2010–2020). Veterinary Surgery (2023).
2. The Middle Ear Microbiota in Healthy Dogs Is Similar to That of the External Ear Canal. Veterinary Sciences (2023).
3. Bacterial meningitis secondary to otogenic infection in 10 French bulldogs: A retrospective case series. Veterinary Record Open (2023).