Sandbox: Otitis media natural history, complications, and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
The prognosis of otitis media is usually good with or without treatment, but varies based on the classification. Acute otitis media is self-limited and usually resolves itself within 14 days, and otitis media with effusion will typically resolve itself within 3-6 months. Chronic suppurative otitis media will usually require surgical or antibiotic intervention to alleviate symptoms and resolve the disease. Acute otitis media rapidly follows the onset of nasopharyngitis; otitis media with effusion and chronic suppurative otitis media may develop following the resolution of acute otitis media symptoms and have a longer symptomatic duration. Complications of otitis media result from the spread of causative infection, as well as damage to the tympanic membrane due to fluid buildup and pressure changes. Presence of complications can increase the morbidity in otitis media patients and decrease the prognosis.
Natural History
- Onset of otitis media rapidly follows the onset of the causative nasopharyngitis.[1]
- Without treatment, acute otitis media (AOM) will usually resolve between 7 and 14 days.[2]
- 80% of children with AOM will experience symptomatic relief without treatment within 2-3 days.
- Otorrhea will usually take longer than symptoms such as fever or ear pain to resolve.[2]
- Otitis media with effusion (OME) will resolve itself without treatment in a period of 3-6 months.[2]
- Complete clearance of middle ear effusion will take longer than symptomatic effects of otitis media due to longer duration of fluid drainage.
- Chronic suppurative otitis media will not usually resolve itself and will remain and recur indefinitely without surgical intervention.[3]
- Symptoms of acute otitis media will recur indefinitely, heightening risk of complications.
Complications
- Complications of otitis media result from the spread of causative infection, as well as damage to the tympanic membrane due to fluid buildup and pressure changes.
- Intracranial and extracranial complications of otitis media include the following:[4]
- Meningitis: the pathogen causing otitis media can spread to the meninges and cause inflammation.
- Brain abscess: result of inflammation from infection spreading to the brain.
- Mastoiditis: infection of the mastoid bone behind the ears caused by the otitis media pathogen.[5]
- Sigmoid sinus thrombosis: otitis media can result in thrombosis of the cerebral veins and sinuses in rare cases.[6]
- Partial hearing loss.[7]
- Tympanic injury requiring surgical reconstruction.[7]
Prognosis
- The prognosis of otitis media is usually good without treatment.
- Acute otitis media will usually resolve itself within 2 weeks.
- Otitis media with effusion will usually resolve itself within 6 months.
- Prognosis of chronic suppurative otitis media without treatment varies on the presence of complications.[8]
- Complications of mastoiditis and meningitis have poor prognosis without treatment.
- With treatment, all classifications of otitis media have a good prognosis.
References
- ↑ Coticchia JM, Chen M, Sachdeva L, Mutchnick S (2013). "New paradigms in the pathogenesis of otitis media in children". Front Pediatr. 1: 52. doi:10.3389/fped.2013.00052. PMC 3874850. PMID 24400296.
- ↑ 2.0 2.1 2.2 Rosenfeld, Richard M.; Kay, David (2010). "Natural history of untreated otitis media". The Laryngoscope. 113 (10): 1645–1657. doi:10.1097/00005537-200310000-00004. ISSN 0023-852X.
- ↑ "www.who.int" (PDF).
- ↑ Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M (2014). "Update on otitis media - prevention and treatment". Infect Drug Resist. 7: 15–24. doi:10.2147/IDR.S39637. PMC 3894142. PMID 24453496.
- ↑ "Mastoiditis: MedlinePlus Medical Encyclopedia".
- ↑ Ropposch T, Nemetz U, Braun EM, Lackner A, Tomazic PV, Walch C (2011). "Management of otogenic sigmoid sinus thrombosis". Otol. Neurotol. 32 (7): 1120–3. doi:10.1097/MAO.0b013e31822a1ec0. PMID 21817936.
- ↑ 7.0 7.1 Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP (2013). "Otitis media: diagnosis and treatment". Am Fam Physician. 88 (7): 435–40. PMID 24134083.
- ↑ Acuin J (2007). "Chronic suppurative otitis media". BMJ Clin Evid. 2007. PMC 2943814. PMID 19454051.