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Otitis MediaAka: Acute Otitis Media, Acute Suppurative Otitis Media, Acute Purulent Otitis Media, Acute Bacterial Otitis Media

Epidemiology
1. Incidence of infection
  1. All children by 1 year of age: 62%
  2. All children by 3 years of age: 83%
2. Average of 1.5 Acute Otitis Media episodes per year
Risks of recurrent Otitis Media or persistent Effusion
1. Age < 5 yrs (5 fold relative risk)
2. Otitis prone (4x) (see below)
3. Day care (4x)
4. Respiratory Illness (4x)
5. Smokers in home (3x)
6. Bottle Propped babies (2x)
7. Males (2x)
8. Pacifiers
Protective Factors against Otitis Media
1. Summer (0.5x)
2. Breast Feeding (0.25x)
Otitis Prone patients
1. Age at first episode of otitis media <6 months
2. Greater than 3 episodes in the last 6 months
3. Race
  1. Native American higher Incidence
  2. African American lower Incidence
4. Sibling history of frequent ear infections
5. Down Syndrome
6. Cleft Palate
7. Immune Deficiency
Pathophysiology
1. Antecedent Event: Upper Respiratory Infection
2. Congestion of resp mucosa
3. Obstruction: isthmus-narrowest part of tube
4. Increased tube negative pressure
5. Development of effusion (serum pulled in)
6. Effusion colonization
Pathogens
1. Streptococcus Pneumoniae
  1. Incidence: 38%
  2. Beta Lactamase producing: 15-25%
  3. Causes more severe cases with Otalgia and fever
2. Haemophilus Influenzae
  1. Incidence: 27%
  2. Beta Lactamase producing: 35%
  3. More often associated with eye redness and discharge
3. Moraxella catarrhalis
  1. Incidence: 10%
  2. Beta Lactamase producing: 85-100%
4. Group-A Beta Hemolytic Streptococcus
  1. Incidence: 3%
5. Staphylococcus aureus
  1. Incidence: 2%
Complications
1. Intracranial
  1. Meningitis
  2. Subdural empyema
  3. Brain Abscess
  4. Lateral sinus thrombosis
  5. Focal Otitis Encephalitis
2. Extracranial
  1. Hearing Loss
  2. Tympanic Membrane Perforation
  3. Chronic Suppurative Otitis Media
  4. Mastoiditis
  5. Cholesteatoma
  6. Facial Paralysis
  7. Tympanosclerosis
  8. Labyrinthitis
Diagnosis
1. See Otitis Media Diagnosis
Management
1. See Otitis Media Acute Treatment
2. See Otitis Media Prophylaxis
References

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This page was written by Scott Moses, MD. This page was last revised on 4/26/2008 9:11:09 PM. This page was last published on 4/29/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.