Otitis Media

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

1. 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
2. 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
3. Protective Factors against Otitis Media
   1. Summer (0.5x)
   2. Breast Feeding (0.25x)
4. 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
5. 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
6. Pathogens
   1. Streptococcus Pneumoniae
      1. Incidence: 38%
      2. Beta Lactamase producing: 15-25%
      3. Causes more severe cases with Otalgia and fever
   2. HaemophilusInfluenzae
      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%
7. 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
8. Diagnosis
   1. See Otitis Media Diagnosis
9. Management
   1. See Otitis Media Acute Treatment
   2. See Otitis Media Prophylaxis
10. References
    1. Daly (1991) Otolaryngol Clin North Am 24:775-86
    2. Daly (1999) Pediatrics 103:1158-66
    3. Klein (1994) Clin Infect Dis 19:823-32
    4. Palmu (2004) Clin Infect Dis 38:234-42
    5. Teele (1989) J Infect Dis 160:83-94