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Otitis Media

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Otitis Media, Acute Otitis Media, Acute Suppurative Otitis Media, Acute Purulent Otitis Media, Acute Bacterial Otitis Media

  • See Also
  1. Otitis Media Diagnosis
  2. Otitis Media Acute Treatment
  3. Observation Protocol for Acute Otitis Media Management
  4. Otitis Media Prophylaxis
  • Epidemiology
  1. Incidence of infection
    1. All children by 1 year of age: 62%
    2. All children by 3 years of age: 83%
  2. Average of 1.5 Acute Otitis Media episodes per year
  3. Peak Incidence at age 6-15 months (decreases after 24 months)
  • Risk Factors
  • Recurrent Otitis Media or persistent Effusion
  1. Age < 5 years old (5 fold Relative Risk)
  2. Otitis prone (4x) (see below)
  3. Day care (4x)
  4. Respiratory Illness (4x)
  5. Smokers in home (3x)
  6. Bottle Propped babies (2x)
  7. Males (2x)
  8. Pacifier use after 6 months old
  9. Premature birth before 37 weeks gestation
  10. Gastroesophageal Reflux
  • Risk Factors
  • Protective Factors against Otitis Media
  1. Summer (0.5x)
  2. Breast Feeding (0.25x)
  • Risk Factors
  • Otitis Prone patients
  1. Age at first episode of Otitis Media <6 months
  2. Greater than 3 episodes in the last 6 months
  3. Race
    1. Native American higher Incidence
    2. African American lower Incidence
  4. Sibling history of frequent ear infections
  5. Immune Deficiency
  6. Craniofacial abnormalities
    1. Down Syndrome
    2. Cleft Palate
  • Pathophysiology
  1. Antecedent Event: Upper Respiratory Infection
    1. Congestion of respiratory mucosa
  2. Obstruction of eustachian tube typically at the isthmus (narrowest section
    1. Eustachian tubes in under age 5 years are more likely to obstruct (shorter, more narrow, more horizontal)
    2. Results in increased eustachian tube negative pressure
  3. Middle Ear Serous effusion develops
    1. Serum drawn into the middle ear due to negative pressure
  4. Effusion colonization with Bacteria
    1. Suppurative Otitis Media develops
  • Pathophysiology
  • Pathogens
  1. Streptococcus Pneumoniae
    1. Incidence: 38%
    2. Beta Lactamase producing: 15-25%
    3. Causes more severe cases with Otalgia and fever
  2. Haemophilus Influenzae
    1. Incidence: 27%
    2. Beta Lactamase producing: 35%
    3. More often associated with Eye Redness and discharge
  3. Moraxella catarrhalis
    1. Incidence: 10%
    2. Beta Lactamase producing: 85-100%
  4. Group-A Beta Hemolytic Streptococcus
    1. Incidence: 3%
  5. Staphylococcus aureus
    1. Incidence: 2%
  • Findings
  • Symptoms and Signs
  1. See Otitis Media Symptoms and Signs
  • Complications
  1. Intracranial
    1. Meningitis
    2. Subdural Empyema
    3. Brain Abscess
    4. Lateral Sinus Thrombosis
    5. Focal Otitis Encephalitis
  2. Extracranial
    1. Hearing Loss
    2. Tympanic Membrane Perforation
    3. Chronic Suppurative Otitis Media
    4. Mastoiditis
    5. Cholesteatoma
    6. Facial Paralysis
    7. Tympanosclerosis
    8. Labyrinthitis
  • Diagnosis
  1. See Otitis Media Diagnosis
  2. See Otalgia
  • Management
  1. See Otitis Media Acute Treatment
  2. See Otitis Media Prophylaxis
  • References
  1. Thomas and Kosoko (2022) Crit Dec Emerg Med 36(12): 12-3
  2. Daly (1991) Otolaryngol Clin North Am 24:775-86 [PubMed]
  3. Daly (1999) Pediatrics 103:1158-66 [PubMed]
  4. Gaddey (2019) Am Fam Physician 100(6): 350-6 [PubMed]
  5. Klein (1994) Clin Infect Dis 19:823-32 [PubMed]
  6. Lieberthal (2013) Pediatrics 131(3): e964-99 [PubMed]
  7. Palmu (2004) Clin Infect Dis 38:234-42 [PubMed]
  8. Teele (1989) J Infect Dis 160:83-94 [PubMed]