· The term otitis media is an inflammation of the middle ear.
There are three subtypes of otitis media:
or acute otitis media,
or otitis media with effusion, and
o Chronic otitis media.
· The three are differentiated by the appearance, signs, and symptoms of infection and the presence of fluid in the middle ear.
· Most cases of acute otitis media are caused by viral pathogens.
Some cases are caused by common bacteria and bacterial pathogens include Streptococcus pneumonia, non-typeable Haemophilus influenzae, and Moraxella catarrhalis
Acute bacterial otitis media usually follows a viral infection of the upper respiratory tract that causes Eustachian tube dysfunction and inflammation of the mucosa in the middle ear.
The middle ear is the space behind the tympanic membrane or eardrum.
An uninfected ear has a thin, transparent tympanic membrane.
In otitis media, this space becomes blocked with fluid, resulting in a bulging, erythematous tympanic membrane.
Bacteria that colonize the nasopharynx enter the middle ear and are not adequately removed by the mucociliary system.
Bacteria proliferate and cause infections.
Children tend to be more susceptible to otitis media than adults because the anatomy of the Eustachian tube is shorter and horizontal, which makes it easier for bacteria to enter the middle ear.
Clinical presentation and diagnosis of acute otitis media
Acute onset of signs and symptoms of middle ear infection after cold symptoms such as a runny nose, nasal congestion, or cough
Signs and symptoms
Ear pain that can be severe (> 75% of patients)
Children may be irritable, pull on the affected ear, and have trouble sleeping.
Fever is present in less than 25% of patients and, when present, occurs more frequently in younger children.
Exam shows a bulging, thickened, and discolored (gray) eardrum
Otoscopy or pneumatic tympanometry demonstrates an immobile eardrum
Drainage of fluid from the middle ear occurs in less than 3% of patients and generally has a bacterial etiology.
Gram stain, culture, and sensitivities of fluid drained or aspirated if tympanocentesis is performed
The general approach to treatment
· The first step in treating otitis media is to differentiate acute otitis media from otitis media with effusion or chronic otitis media, since the latter two types do not benefit substantially from antibiotic therapy.
· The second step is to address the pain with oral pain relievers.
Acetaminophen or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen,
Should be offered early to relieve pain in acute otitis media
Additionally, ear drops with a local anesthetic, such as amethocaine, benzocaine, or lidocaine, relieve pain when given with oral pain relievers to children ages 3-18.
The third step is to consider whether a short period of observation is warranted or whether the severity of the disease or the characteristics of the patient require immediate antibiotic therapy.
· Pain and fever tend to go away after 2 to 3 days, and most children become asymptomatic within 7 days.
Treatment failure is the lack of clinical improvement in the signs and symptoms of infection,
· Including pain, fever, and erythema/bulging of the tympanic membrane, after 3 days.
· If antibiotics were initially stopped, they should be instituted now.
If the patient initially received an antibiotic, then the antibiotic should be changed