Otitis Media Disease

DESCRIPTION

Inflammation of the middle ear

Acute otitis media (AOM): Usually a bacterial infection accompanied by viral upper respiratory infection; rapid onset of signs and symptoms
Recurrent AOM: 3 or more AOM in 6 months, or 4 or more AOM in 1 year
Otitis media with effusion (OME): Persistent inflammation manifested as asymptomatic middle ear fluid that follows AOM or arises without prior AOM
Chronic otitis media with or without cholesteatoma
System(s) affected: Nervous
Genetics: May be influenced by skull configuration or immunological defects
Incidence/Prevalence in USA: (Incidence) By age 7 years 93% of children have 1 or more AOM; 39% have 6 or more AOM; after AOM 10 to 20% still have OME 3 months later
Predominant age: Peak incidence age 6-18 months; declines after age 7 years; rare in adults
Predominant sex: Male > Female (for AOM and recurrent AOM)

SIGNS AND SYMPTOMS

AOM:
- Earache
- Fever, although more often afebrile
- Accompanying URI symptoms
- Decreased hearing
- Otorrhea if eardrum perforated
- Eardrum mobility decreased (as observed by pneumatic otoscopy)
- Eardrum bulging, opaque, often yellowish or inflamed. Redness alone is not a reliable sign.
AOM in infants:
- May cause no symptoms in the first few months of life
- Irritability is sometimes the only indication of earache
- Eardrum bulging, opaque, often yellowish or inflamed. Redness alone not a reliable sign.
OME:
- Usually asymptomatic
- Decreased hearing probably universal, but not always measurable, and rarely appreciated by parents
- Eardrum often dull, but not bulging
- Eardrum mobility decreased (as observed by pneumatic otoscopy)

CAUSES

AOM: A preceding viral upper respiratory infection produces eustachian tube dysfunction that is thought to promote bacterial infection via eustachian tube. Bacteriology:
- Pneumococci: 30-35%
- Haemophilus influenzae: 20-25%; 40% of these produce beta-lactamases that hydrolyze amoxicillin and some cephalosporins
- Moraxella (Branhamella) catarrhalis: 10-15%; 90% of these produce beta-lactamases that hydrolyze amoxicillin and some cephalosporins
- Group A streptococci: 3%
- Staphylococcus aureus: 1-2%
- Sterile/non-pathogens: 25-30%
OME:
- 20-40% silent bacterial infection
- Eustachian tube dysfunction thought important
- Allergic causes rarely substantiated

RISK FACTORS

Day care
Formula feeding
Smoking in household
Male gender
Family history of middle ear disease
AOM in 1st year of life is a risk factor for recurrent AOM
Sibling history of otitis media

LABORATORY

WBC higher in bacterial AOM than in sterile AOM
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

To document the presence of middle ear fluid - tympanometry, acoustic reflex measurement or acoustic reflectometry
Hearing testing helpful to assess the need for early surgical intervention in OME
Nasopharyngoscopy

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Tympanocentesis for microbiologic diagnosis recommended for treatment failures, may be followed by myringotomy

APPROPRIATE HEALTH CARE

Outpatient except when surgery is indicated

GENERAL MEASURES

AOM: Outpatient except for febrile infants < 2 months
May use watchful waiting approach, treating symptoms without antibiotics for first 2-3 days. If symptoms persist, then amoxicillin is first line treatment.

SURGICAL MEASURES

OME: Referral for surgery if: > 4-6 months bilateral OME, and/or > 6 months unilateral OME, and/or hearing loss > 25 decibels
Recurrent AOM: Referral for surgery if > 2 or 3 AOM while on chemoprophylaxis
Tympanostomy tubes and adenoidectomy: Effective surgical procedures for OME and recurrent AOM, but not in all cases

ACTIVITY

No restrictions

DIET

No special diet

PATIENT EDUCATION

N/A

PREVENTION/AVOIDANCE

Breast-feeding decreases incidence of AOM
Eliminate cigarette smoking in the household

POSSIBLE COMPLICATIONS

AOM: Perforation/otorrhea, acute mastoiditis, facial nerve paralysis, otitic hydrocephalus, meningitis
OME: Hearing loss. Extent and significance of impaired speech and language is controversial.
Recurrent AOM and OME: Atrophy and scarring of eardrum, chronic perforation and otorrhea, cholesteatoma, permanent hearing loss, chronic mastoiditis, brain abscess and other intracranial suppurative complications

EXPECTED COURSE AND PROGNOSIS

AOM: Symptoms usually improve in 48-72 hrs; OME following AOM resolved in 90% by 3 months
OME: Approximately 50% resolve after 8 weeks of observation
Recurrent AOM and OME: Usually subside in school age children; only a small percentage have complications

ASSOCIATED CONDITIONS

Upper respiratory infection
Bacteremia
Meningitis
Allergies

AGE-RELATED FACTORS

Pediatric: Primarily a pediatric disease
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

In first few months of infancy, the eardrum is normally at an angle and less mobile in older adults

ABBREVIATIONS

AOM = acute otitis media
OM = otitis media
OME = otitis media with effusion

Clinical Investigations

ROLE OF HOMOEOPATHY

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