otitic


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Related to otitic: otitic barotrauma, otitic hydrocephalus

o·tit·ic

(ō-tit'ik),
Relating to otitis.

otitic

[ōtit′ik]
Etymology: Gk, ous, ear
pertaining to otitis.

o·tit·ic

(ō-tit'ik)
Relating to otitis.

otitis

(o-tit'is) [ oto- + -itis]
Inflammation of the ear. It is differentiated as externa, media, and interna, depending upon which portion of the ear is inflamed. otitic (o-tit'ik), adjective

acute otitis media

Abbreviation: AOM
The presence of fluid in the middle ear accompanied by signs and symptoms of local or systemic infection. In the U.S. 12,000,000 cases of otitis media are estimated to occur each year. More than 90% of children experience at least one episode by age 2 years. Because infants and children have short, horizontal eustachian tubes, they are at risk for obstructions of the middle ear, allowing fluid to accumulate and bacteria to proliferate in the fluid, resulting in inflammation and infection.

Etiology

The most common causes are viruses, such as respiratory syncytial virus (RSV) and influenza virus, and bacteria, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Risk factors for middle ear infection include age under 2 years, exposure to family members or others with respiratory infections, day care attendance, lower socioeconomic status, exposure to second-hand smoke or wood-burning stoves, allergies, excessive use of a pacifier, and feeding with a propped bottle or in a supine position.

signs and symptoms

There may be pain in the ear, drainage of fluid from the ear canal, ear-tugging, and hearing loss. Systemic signs include fever, irritability, headache, lethargy, anorexia, and vomiting. Diarrhea is also a common sign of AOM in infants. History of a recent upper respiratory infection is common.

Treatment

Since AOM is usually self-limiting and resolves in 1 to 2 weeks without antibiotics, the best approach is to watch and wait. Parents should be told that if the child does not show improvement in 2 to 3 days, an antibiotic may be needed, but that inappropriate use of antibiotics leads to bacteria that are resistant to these drugs. Antibiotics, however, should be prescribed for the child under age 2 or when the eardrum is bulging and fever is present. Amoxicillin is the drug of choice when antibiotics are required. Parents should be warned that if improvement is not seen in 2 to 3 days on this therapy, the primary care provider should be notified, because this may indicate that the causative bacteria are amoxicillin-resistant, requiring a different drug, such as amoxicillin-clavulanate (Augmentin), cefuroxime (Ceftin) or ceftriaxone (Rocephin). Anesthetic eardrops may be prescribed if the tympanic membrane is intact and there is no discharge from the ear. Antihistamines, decongestants, homeopathic, and naturopathic remedies are not beneficial in AOM and should not be given. Pain is usually treated with acetaminophen or ibuprofen. Cold or hot pack applications help to ease the pain, as does positioning the child with the head propped up. Some evidence suggests that vaccinations against common viral illnesses (such as influenza and RSV) will diminish the incidence of AOM.

Vaccination against Streptococcus pneumoniae prevents ear infections and limits the need for giving antibiotics in children.

Diagnosis

Clinical diagnosis relies on the visualization of a red tympanic membrane with limited mobility (established by pneumatic otoscopy or tympanogram). Definitive diagnosis of the causative organism relies on tympanocentesis, that is, puncturing the eardrum with a needle to aspirate and culture the fluid in the middle ear. This test is rarely performed in routine outpatient care.

Patient care

Because some children are prone to recurrences, parents should be taught to recognize signs of otitis media and seek medical assistance when their child complains of pain or when they observe the child tugging his ears or demonstrating pain in other ways. Parents should be taught to help prevent recurrent AOM by not smoking or allowing smoking around children. Parents who smoke should be encouraged to quit or at least to limit their smoking to out-of-doors. Use of pacifiers should be limited because the pressure of vigorous sucking opens the eustachian tubes and allows nasopharyngeal secretions to enter the middle ear. Breast-feeding should be encouraged for at least the first 3 months to enhance transfer of antibodies and reduction of infections. Bottle-fed infants should never be propped with the bottle and should have the head elevated during feedings. Parents should be reminded that good hand hygiene is the best way to prevent the spread of infections and that, if the child is in day-care, they should make sure the facility has soap and sinks readily available and enforces hand hygiene policies. Failure to treat acute and chronic ear infections may lead to spontaneous rupture of the eardrum, temporary or permanent hearing loss in children, and subsequent communication disorders; therefore, parents must understand the importance of proper medical follow-up. The child should be referred to an ear, nose, and throat (ENT) specialist for evaluation in the presence of recurrent AOM (6 episodes in 12 months), associated complications (mastoiditis), AOM that does not respond to treatment, and problems with hearing, speech, or language.

allergic otitis media

Otitis media with effusion.

otitis externa

Infection or inflammation of the external auditory canal. It may be caused by a contact allergy, an acute bacterial infection, or by fungi. In diabetics and the immunosuppressed patient, the infection may invade the base of the skull, resulting in deep bone infection.

furuncular otitis

A furuncle formation in the external meatus of the ear.

otitis interna

Labyrinthitis.

otitis labyrinthica

Inflammation of the labyrinth of the ear.

otitis mastoidea

Inflammation of the middle ear, involving the mastoid spaces.

otitis media

Acute otitis media.

otitis media with effusion

The presence of fluid in the middle ear without signs or symptoms of acute infection. This causes retraction of the eardrum. Upon examination, a level of air fluid may be seen through the tympanic membrane. The cause of the obstruction may be enlarged adenoid tissue in the pharynx, inflammation in the pharynx, tumors in the pharyngeal area, or allergy. Synonym: allergic otitis media; nonsuppurative otitis media; secretory otitis media; serous otitis media

Treatment

Nasal decongestants may afford symptomatic relief. The use of antibiotics is controversial. Adenoidectomy and bilateral myringotomy may be necessary if conservative measures, including insertion of a ventilation or tympanostomy tube, are not effective. Adenoidectomy is not advisable in children under 4 years of age. See: tympanocentesis; tympanostomy tube

CAUTION!

The routine use of grommets, also called ventilation tubes, as part of the initial therapy for otitis media is not advised. Their use should be reserved for persistent or recurrent infections that have failed to respond to appropriate therapy.

otitis mycotica

Inflammation of the ear caused by a fungal infection.

necrotizing otitis externa

Infection of the base of the skull that originates in the external auditory canal. It is usually caused by infection with the bacterium Pseudomonas aeruginosa. The disease occurs most often in diabetic and other immunocompromised patients. It may be life-threatening and requires prolonged antibiotic therapy. Hyperbaric oxygen treatments are used in patients with the most advanced and refractory disease.

nonsuppurative otitis media

Otitis media with effusion.

otitis parasitica

Inflammation of the ear caused by a parasite.

otitis sclerotica

Inflammation of the inner ear accompanied by hardening of the aural structures.

secretory otitis media

Otitis media with effusion.

serous otitis media

Otitis media with effusion.