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| {{Otitis media}} | | {{Otitis media}} |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information, click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}} {{AE}} {{LRO}} {{Maliha}}; {{SC}}; {{MM}}; |
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| | {{SK}} Acute otitis media; otitis media with effusion; chronic suppurative otitis media; chronic otitis media; recurrent otitis media; AOM; CSOM; OME; middle ear infection; chronic mastoiditis; chronic tympanomastoiditis; middle ear inflammation |
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| ==Otorrhea: infected drainage from the middle ear== | | ==[[Otitis media overview|Overview]]== |
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| When the middle ear becomes acutely infected by bacteria, pressure builds up behind the ear drum, usually but not always causing pain. In severe or untreated cases, the tympanic membrane may rupture, allowing the pus in the middle ear space to drain into the ear canal. If there is enough of it, this drainage may be obvious. Even though the rupture of the tympanic membrane suggests a traumatic process, it is almost always associated with the dramatic relief of pressure and pain. In a simple case of acute otitis media in an otherwise healthy person, the body's defenses are likely to resolve the infection and the ear drum nearly always heals. Antibiotic administration can prevent perforation of the eardrum and hasten recovery of the ear.
| | ==[[Otitis media historical perspective|Historical Perspective]]== |
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| Instead of the infection and eardrum perforation resolving, however, drainage from the middle ear can become a chronic condition. As long as there is active middle ear infection, the eardrum will not heal. The [[World Health Organization]] defines Chronic Suppurative Otitis Media (CSOM) as "a stage of ear disease in which there is chronic infection of the middle ear cleft, a non-intact tympanic membrane (i.e. perforated eardrum) and discharge (otorrhoea), for at least the preceding two weeks" (WHO 1998). (Notice WHO's use of the term ''serous'' to denote a bacterial process, whereas the same term is generally used by ear physicians in the United States to denote simple fluid collection within the middle ear behind an intact eardrum. ''Chronic otitis media'' is the term used by most ear physicians worldwide to describe a chronically infected middle ear with eardrum perforation.)
| | ==[[Otitis media pathophysiology|Pathophysiology]]== |
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| ==Susceptibility in children== | | ==[[Otitis media causes|Causes]]== |
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| Children below the age of seven years are much more prone to otitis media since the Eustachian tube is shorter and at more of a horizontal angle than in the adult ear. They also have not developed the same resistance to viruses and bacteria as adults. Numerous studies have correlated the incidence of acute otitis media in children with various factors such as nursing in infancy, bottle feeding when supine, parental smoking, diet, allergies and automobile emissions; but the most obvious weakness of such studies is the inability to control the variable of exposure to viral agents during the studies. One must also keep in mind that [[Correlation does not imply causation|correlation does not establish causation]]. Breastfeeding for the first twelve months of life is associated with a reduction in the number, and duration of all OM infections.<ref name="pmid7751991">{{cite journal |author=Dewey KG, Heinig MJ, Nommsen-Rivers LA |title=Differences in morbidity between breast-fed and formula-fed infants |journal=J. Pediatr. |volume=126 |issue=5 Pt 1 |pages=696–702 |year=1995 |pmid=7751991 |doi=}}</ref>
| | ==[[Otitis media classification|Classification]]== |
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| ==Treatment== | | ==[[Differentiating otitis media from other diseases|Differentiating Otitis Media from Other Diseases]]== |
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| ===Acute otitis media=== | | ==[[Otitis media epidemiology and demographics|Epidemiology and Demographics]]== |
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| Treatment of acute otitis media is controversial. Much of the controversy centers around the difficulty of distinguishing viral infection from bacterial infection and the fact that viral infection can progress to bacterial infection at any time. Primary care providers, such as general practitioners and pediatricians, often have a monocular [[otoscope]] and perhaps a [[tympanometer]] as their only diagnostic tools, which makes this distinction difficult, especially if the canal is small and there is wax in the ear that obscures a clear view of the eardrum. Also, an upset child's crying can cause the eardrum to look inflamed due to causing distention of the small blood vessels on it, mimicking the redness associated with otitis media. Because of a tradition of inappropriate prescribing of antibiotics for viral acute otitis media, their use has recently been condemned by many primary care practitioners for most cases of acute otitis media. Ear specialists tend to disagree with this philosophy and promote efforts to distinguish between viral and bacterial infection, so as to optimize treatment results by giving antibiotics only for bacterial infection. Acute bacterial otitis media can cause pain that leads to sleepless nights for both children and parents, can cause eardrum perforations, not all of which heal, and can spread to cause mastoiditis and/or meningitis, brain abscess, and even death if a severe infection goes untreated long enough. High fever can occur and can cause febrile seizures. Appropriate antibiotic administration prevents most such complications. On the other hand, it is generally agreed that acute otitis media that is purely viral will usually resolve without antibiotic treatment, although associated persistent middle ear effusions may require medical intervention.<ref>{{cite journal | author = Damoiseaux R, van Balen F, Hoes A, Verheij T, de Melker R | title = Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years. | journal = BMJ | volume = 320 | issue = 7231 | pages = 350-4 | year = 2000 | id = PMID 10657332}}</ref><ref>{{cite journal | author = Arroll B | title = Antibiotics for upper respiratory tract infections: an overview of Cochrane reviews. | journal = Respir Med | volume = 99 | issue = 3 | pages = 255-61 | year = 2005 | id = PMID 15733498}}</ref><ref>{{cite journal | author = Rovers MM, Glasziou P, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, Gaboury I, Little P, Hoes AW. | title = Antibiotics for acute otitis media: a meta-analysis with individual patient data. | journal = Lancet. | volume = 368 | issue = 9545 | pages = 1429-35 | year = 2006 | id = PMID 17055944}}</ref>
| | ==[[Otitis media risk factors|Risk Factors]]== |
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| Many guidelines now suggest deferring the start of antibiotics for one to three days<!--
| | ==[[Otitis media natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| --><ref>{{cite journal | author = Damoiseaux R | title = Antibiotic treatment for acute otitis media: time to think again. | journal = CMAJ | volume = 172 | issue = 5 | pages = 657-8 | year = 2005 | id = PMID 15738492}}</ref>
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| avoiding the need for antibiotics for two out of three children<!--
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| --><ref>{{cite journal | author = Marchetti F, Ronfani L, Nibali S, Tamburlini G | title = Delayed prescription may reduce the use of antibiotics for acute otitis media: a prospective observational study in primary care. | journal = Arch Pediatr Adolesc Med | volume = 159 | issue = 7 | pages = 679-84 | year = 2005 | id = PMID 15997003}}</ref>
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| without adverse effect on longterm outcomes for those whose treatment is deferred.<!--
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| --><ref>{{cite journal | author = Little P, Moore M, Warner G, Dunleavy J, Williamson I | title = Longer term outcomes from a randomised trial of prescribing strategies in otitis media. | journal = Br J Gen Pract | volume = 56 | issue = 524 | pages = 176-82 | year = 2006 | id = PMID 16536957}}</ref> First line antibiotic treatment, if warranted, is [[amoxicillin]]. If the bacteria is resistant, then [[co-amoxiclav|amoxicillin-clavulanate]] or another penicillin derivative plus beta lactamase inhibitor is second line.
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| Prior to the invention of [[antibiotics]], severe acute otits media was mainly remedied surgically by [[Myringotomy]]. An outpatient procedure, it consists of making a small incision in the [[tympanic membrane]] to relieve pressure build-up.
| | ==Diagnosis== |
| | [[Otitis media history and symptoms|History and Symptoms]] | [[Otitis media physical examination|Physical Examination]] | [[Otitis media laboratory findings|Laboratory Findings]] | [[Otitis media CT or MRI|CT or MRI]] | [[Otitis media other imaging findings|Other Imaging Findings]] |
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| ===Chronic cases or with effusion=== | | ==Treatment== |
| | | [[Otitis media medical therapy|Medical Therapy]] | [[Otitis media surgery|Surgery]] | [[Otitis media prevention|Prevention]] | [[Otitis media cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] |
| In chronic cases or with effusions present for months, surgery is sometimes performed by an otolaryngologist (ear, nose, and throat specialist) or by an otologist (ear specialist), to insert a [[grommet]] (called a "[[tympanostomy tube]]") into the [[eardrum]] to allow air to pass through into the [[middle ear]], and thus release any pressure buildup and help clear excess fluid within.
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| For chronic cases (glue ear), it is possible to use the [[Valsalva maneuver]] to reestablish middle ear ventilation, although repeated use of the Valsalva maneuver can cause infected matter to enter the eye cavity and cause [[conjunctivitis]].
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| ===Alternative therapies=== | | ==Case Studies== |
| | | [[Otitis media case study one|Case #1]] |
| Alternatives to conventional medical approaches include [[chiropractic]] and [[Osteopathic medicine in the United States|osteopathic]] spinal manipulations, targeted to relieve muscle tension to enhance lymphatic flow and allow normal opening of the Eustachian tube. Such alternatives are becoming increasingly widely used. Otitis Media has also been found to respond to [[homeopathic]] remedies.<ref>{{cite book | title = Childhood Ear Infections: A Parent's Guide to Alternative Treatments | author = Michael A. Schmidt | publisher = North Atlantic Books | year = 2003 | isbn = 1556434421 }} [http://books.google.com/books?id=7DPwoHjD_bAC&pg=PA147&dq=osteopathy+%22otitis+media%22+chiropractic&lr=&as_brr=0&ei=7UrKR8TDLILusgO_r_XBAw&sig=rNkOdI8AQJiSex76-Kjaakj0i_8] [http://books.google.com/books?id=nGjDjqaz-fAC&pg=PA120&dq=homeopathy+%22otitis+media%22&lr=&as_brr=0&ei=7kzKR6qxEoOotgOd4aHBAw&sig=KX0P1K64Ky0mm6GvY8kBrj5joqw#PPA119,M1 ]</ref>
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| Eardoc treatment reduces the fluids in the middle ear by opening the [[Eustachian tube]]. Its efficiency can be viewed and tested with a [[tympanometer]].
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| ==Gallery==
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| <gallery>
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| Image:Otitis media bullös.jpg|Otitis media acuta - Myringitis bullosa
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| Image:Otitis media entdifferenziert2.jpg
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| Image:Otitis media grippe.jpg|Influenza
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| Image:Otitis media incipient.jpg|Otitis media acuta
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| Image:Otitis media schollig.jpg|Otitis media acuta
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| Image:Otitis chron mesotymp 7.jpg|Otitis media chronica mesotympanalis
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| Image:Otitis chron mesotymp 4.jpg|Otitis media chronica mesotympanalis
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| Image:Otitis chron mesotymp 3.jpg|Otitis media chronica mesotympanalis
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| Image:Otitis chron mesotymp 1.jpg|Otitis media chronica mesotympanalis
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| </gallery>
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| ==Sources== | | ==Sources== |
| *[http://www.nidcd.nih.gov/health/hearing/otitismedia.asp NIH]
| | [http://www.nidcd.nih.gov/health/hearing/otitismedia.asp NIH] |
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| {{Diseases of the ear and mastoid process}} | | {{Diseases of the ear and mastoid process}} |
| {{Common Cold}} | | {{Common Cold}} |
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| [[Category:Disease]]
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| [[Category:Infectious disease]]
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| [[Category:Inflammations]]
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| [[Category:Otolaryngology]]
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| [[Category:Otology]]
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| [[Category:Pediatrics]]
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| [[ay:Jinchu usu]] | | [[ay:Jinchu usu]] |
| [[bg:Отит]] | | [[bg:Отит]] |
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