Otitis media is inflammation or infection of the middle ear. It occurs in four acute forms: serous otitis media, otitis media with effusion, acute purulent otitis media, and secretory otitis media. Mastoiditis is an infection and inflammation of the mastoid antrum air cells. A cholesteatoma is a cyst-like mass filled with keratin debris.

These conditions are triggered or accelerated by gram-positive, gram-negative or viral infections. In otitis media, fluid accumulates as a result of blockage of the eustachian tube or excessive production of middle ear fluid. Mastoiditis may result as a complication of acute or chronic otitis media. A cholesteatoma is most common in the middle ear (see Diagnostic Code: 6209 Benign neoplasms of the ear) but may also involve the mastoid air cells. Otitis media with effusion is usually associated with middle fluid accumulation and infection after antibiotic therapy. In acute purulent (suppurative) otitis media, pus fills the middle ear. Secretory otitis media occurs after recurrent or prolonged episodes of otitis media where there may be changes in the lining of the middle ear producing thicker fluid in greater quantities.

Signs and symptoms of otitis media may include: severe, deep throbbing pain in the ear; a feeling of fullness; signs of upper respiratory tract infection; mild to high fever; chills; dizziness; and nausea and vomiting. Obscured or distorted bony landmarks of the tympanic membrane may be seen by otoscopic examination. There also may be bulging of the tympanic membrane with erythema. Otorrhea in the ear canal may be present due to tympanic membrane rupture. Other conditions associated with otitis media may include: inflammation of the air cells of the mastoid process (mastoiditis); petrositis; facial paralysis; conductive and sensorineural hearing loss; labyrinthitis (see Diagnostic Code: 6204 Peripheral vestibular disorders) and headaches.

Tests may include otoscopy and pneumatoscopy that may show decreased tympanic membrane mobility. X-rays, routine or computed tomography (CT) scans, are performed in suspected cases of mastoiditis. Audiometry and tympanometry are required to assess objectively hearing and middle ear function.

Treatment includes antibiotics and pain management. Surgery may be required, ranging from myringotomy and tube insertion, tympanomastoidectomy to radical mastoidectomy. If a cyst-like mass is present in the middle ear, surgical removal may be required.

Residuals may include hearing loss, facial paralysis, chronic dizziness or in extreme cases intracranial infections.

• Compensation is payable for the combinations of service-connected and nonservice-connected disabilities specified in 38 CFR 3.383(a)(3) (see below) as if both disabilities were service-connected, provided the nonservice-connected disability is not the result of the veteran's own willful misconduct.
• Hearing impairment in one ear compensable to a degree of 10 percent or more as a result of service-connected disability and hearing impairment as a result of nonservice-connected disability that meets the provisions of 38 CFR 3.385 in the other ear.

Notes

• Evaluate hearing impairment, and complications such as labyrinthitis, tinnitus, facial nerve paralysis, or bone loss of skull, separately. (38 CFR 4.87 [Schedule of ratings-ear])
• If there is continuous SC infection of the upper respiratory tract, the time cited for the purpose of service connecting infection of the second ear should be extended indefinitely.