Otitis Media

Otitis Media is a topic covered in the 5-Minute Pediatric Consult.

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Basics

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

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