Otitis media

Jump to navigation Jump to search

Otitis media Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Classification

Differentiating Otitis Media from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT or MRI

Other Imaging Findings

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Case Studies

Case #1

Otitis media On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Otitis media

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA onOtitis media

CDC on Otitis media

media in the news

on Otitis media

Directions to Hospitals Treating Otitis media

Risk calculators and risk factors for Otitis media

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Otorrhea: infected drainage from the middle ear

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.

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.)

Susceptibility in children

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 establish causation. Breastfeeding for the first twelve months of life is associated with a reduction in the number, and duration of all OM infections.[1]

Treatment

Acute otitis media

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.[2][3][4]

Many guidelines now suggest deferring the start of antibiotics for one to three days[5] avoiding the need for antibiotics for two out of three children[6] without adverse effect on longterm outcomes for those whose treatment is deferred.[7] First line antibiotic treatment, if warranted, is amoxicillin. If the bacteria is resistant, then amoxicillin-clavulanate or another penicillin derivative plus beta lactamase inhibitor is second line.

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.

Chronic cases or with effusion

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.

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.

Alternative therapies

Alternatives to conventional medical approaches include chiropractic and 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.[8] Eardoc treatment reduces the fluids in the middle ear by opening the Eustachian tube. Its efficiency can be viewed and tested with a tympanometer.


Gallery

Sources

Template:Diseases of the ear and mastoid process Template:Common Cold ay:Jinchu usu bg:Отит da:Mellemørebetændelse de:Akute Mittelohrentzündung id:Otitis media it:Otite media la:Otitis media acuta nl:Middenoorontsteking qu:Rinri nanay fi:Korvatulehdus sv:Öroninflammation

Template:WikiDoc Sources

  1. Dewey KG, Heinig MJ, Nommsen-Rivers LA (1995). "Differences in morbidity between breast-fed and formula-fed infants". J. Pediatr. 126 (5 Pt 1): 696–702. PMID 7751991.
  2. Damoiseaux R, van Balen F, Hoes A, Verheij T, de Melker R (2000). "Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years". BMJ. 320 (7231): 350–4. PMID 10657332.
  3. Arroll B (2005). "Antibiotics for upper respiratory tract infections: an overview of Cochrane reviews". Respir Med. 99 (3): 255–61. PMID 15733498.
  4. Rovers MM, Glasziou P, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, Gaboury I, Little P, Hoes AW. (2006). "Antibiotics for acute otitis media: a meta-analysis with individual patient data". Lancet. 368 (9545): 1429–35. PMID 17055944.
  5. Damoiseaux R (2005). "Antibiotic treatment for acute otitis media: time to think again". CMAJ. 172 (5): 657–8. PMID 15738492.
  6. Marchetti F, Ronfani L, Nibali S, Tamburlini G (2005). "Delayed prescription may reduce the use of antibiotics for acute otitis media: a prospective observational study in primary care". Arch Pediatr Adolesc Med. 159 (7): 679–84. PMID 15997003.
  7. Little P, Moore M, Warner G, Dunleavy J, Williamson I (2006). "Longer term outcomes from a randomised trial of prescribing strategies in otitis media". Br J Gen Pract. 56 (524): 176–82. PMID 16536957.
  8. Michael A. Schmidt (2003). Childhood Ear Infections: A Parent's Guide to Alternative Treatments. North Atlantic Books. ISBN 1556434421. [2] [3]