Otitis Media

Description

Otitis media is a general term for middle ear inflammation with or without symptoms. It can be acute or chronic.

• Two specific diagnoses
  • Otitis media with effusion, middle ear effusion (MEE)
  • Acute otitis media (AOM)
    • Uncomplicated/nonsevere
    • Severe
    • Recurrent

Epidemiology

• Most common condition for which antibacterial agents are prescribed for children in the United States
• Peak incidence between 6 and 12 months of age
• By age 3 years, 50–85% of children have had AOM.

Risk Factors

• Age <2 years
• Gender: male > female
• Family history of AOM
• Anatomic differences, craniofacial abnormalities
• Environmental tobacco smoke exposure
• Exposure to large numbers of other children
  • Day care
  • Siblings in home

General Prevention

• Breastfeeding for at least 3 to 6 months
• Decreasing pacifier use after 6 months
• Vaccines
  • Pneumococcal conjugate vaccine
  • Influenza vaccine
• Reduction in secondhand smoke
• Reduction of day care crowding

Pathophysiology

• Eustachian tube dysfunction leads to MEE. If effusion is not cleared by the mucociliary system, bacteria and viruses have a good environment for growth.
• Severe eustachian tube dysfunction occurs during 66% of upper respiratory infections (URIs) in school-aged children and in 75% of URIs in day care–aged children.

Etiology

• Nontypeable Haemophilus influenzae: 35–50%
• Streptococcus pneumoniae: 25–40%
• Moraxella catarrhalis: 5–10%
• Viruses: 40–75%
  • High rate of coinfection with bacteria
  • Without bacterial coinfection: 5–22%
• Group A Streptococcus (3%)
• Staphylococcus aureus (2%)
• Gram-negative organisms such as Pseudomonas aeruginosa: 1–2%
  • More common in neonatal AOM