otitis media


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Related to otitis media: Otitis Media with Effusion, Acute otitis media

Otitis Media

 

Definition

Otitis media is an infection of the middle ear space, behind the eardrum (tympanic membrane). It is characterized by pain, dizziness, and partial loss of hearing.

Description

A little knowledge of the basic anatomy of the middle ear will be helpful for understanding the development of otitis media. The external ear canal is that tube which leads from the outside opening of the ear to the structure called the tympanic membrane. Behind the tympanic membrane is the space called the middle ear. Within the middle ear are three tiny bones, called ossicles. Sound (in the form of vibration) causes movement in the eardrum, and then the ossicles. The ossicles transmit the sound to a structure within the inner ear, which sends it to the brain for processing.
The nasopharynx is that passageway behind the nose which takes inhaled air into the breathing tubes leading to the lungs. The eustachian tube is a canal which runs between the middle ear and the nasopharynx. One of the functions of the eustachian tube is to keep the air pressure in the middle ear equal to that outside. This allows the eardrum and ossicles to vibrate appropriately, so that hearing is normal.
By age three, almost 85% of all children will have had otitis media at least once. Babies and children between the ages of six months and six years are most likely to develop otitis media. Children at higher risk factors for otitis media include boys, children from poor families, Native Americans, Native Alaskans, children born with cleft palate or other defects of the structures of the head and face, and children with Down syndrome. Exposure to cigarette smoke significantly increases the risk of otitis media as well as other problems affecting the respiratory system. Also, children who enter daycare at an early age have more upper respiratory infections (URIs or colds), and thus more cases of otitis media. The most usual times of year for otitis media to strike are in winter and early spring (the same times URIs are most common).
Otitis media is an important problem, because it often results in fluid accumulation within the middle ear (effusion). The effusion can last for weeks to months. Effusion within the middle ear can cause significant hearing impairment. When such hearing impairment occurs in a young child, it may interfere with the development of normal speech.
In adults, acute otitis media can lead to such complications as paralysis of the facial nerves. Recovery from these complications may take from two weeks to as long as three months.

Causes and symptoms

The first precondition for the development of acute otitis media is exposure to an organism capable of causing the infection. Otitis media can be caused by either viruses or bacteria. Virus infections account for about 15% of cases. The three most common bacterial pathogens are Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis. As of 2003, about 75% of ear infections caused by S. pneumoniae are reported to be penicillin-resistant.
Otitis media may also be caused by other disease organisms, including Bordetella pertussis, the causative agent of whooping cough, and Pneumocystis carinii, which often causes opportunistic infections in patients with AIDS.
There are other factors which make the development of an ear infection more likely. Because the eustachian tube has a more horizontal orientation and is considerably shorter in early childhood, material from the nasopharynx (including infection-causing organisms) is better able to reach the middle ear. Children also have a lot of lymph tissue (commonly called the adenoids) in the area of the eustachian tube. These adenoids may enlarge with repeated respiratory tract infections (colds), ultimately blocking the eustachian tubes. When the eustachian tube is blocked, the middle ear is more likely to fill with fluid. This fluid, then, increases the risk of infection, and the risk of hearing loss and delayed speech development.
Most cases of acute otitis media occur during the course of a URI. Symptoms include fever, ear pain, and problems with hearing. Babies may have difficulty feeding. When significant fluid is present within the middle ear, pain may increase depending on position. Lying down may cause an increase in painful pressure within the middle ear, so that babies may fuss if not held upright. If the fluid build-up behind the eardrum is sufficient, the eardrum may develop a hole (perforate), causing bloody fluid or greenish-yellow pus to drip from the ear. Although pain may be significant leading up to such a perforation, the pain is usually relieved by the reduction of pressure brought on by a perforation.
Recent advances in gene mapping have led to the discovery of genetic factors that increase a child's susceptibility to otitis media. Researchers are hoping to develop molecular diagnostic assays that will help to identify children at risk for severe ear infections.

Diagnosis

Diagnosis is usually made simply by looking at the eardrum through a special lighted instrument called an otoscope. The eardrum will appear red and swollen, and may appear either abnormally drawn inward, or bulging outward. Under normal conditions, the ossicles create a particular pattern on the eardrum, referred to as "landmarks." These landmarks may be obscured. Normally, the light from the otoscope reflects off of the eardrum in a characteristic fashion. This is called the "cone of light." In an infection, this cone of light may be shifted or absent.
A special attachment to the otoscope allows a puff of air to be blown lightly into the ear. Normally, this should cause movement of the eardrum. In an infection, or when there is fluid behind the eardrum, this movement may be decreased or absent.
If fluid or pus is draining from the ear, it can be collected. This sample can then be processed in a laboratory to allow any organisms present to multiply sufficiently (cultured) to permit the organisms to be viewed under a microscope and identified.
Otitis media is an ear infection in which fluid accumulates within the middle ear. A common condition occurring in childhood, it is estimated that 85% of all American children will develop otitis media at least once.
Otitis media is an ear infection in which fluid accumulates within the middle ear. A common condition occurring in childhood, it is estimated that 85% of all American children will develop otitis media at least once.
(Illustration by Electronic Illustrators Group.)

Treatment

Medications

Antibiotics are the treatment of choice for acute otitis media (AOM). Different antibiotics are used depending on the type of bacteria most likely to be causing the infection. This decision involves knowledge of the types of antibiotics that have worked on other ear infections occurring within a particular community at a particular time. Options include sulfa-based antibiotics, as well as a variety of penicillins, cephalosporins, and others. The patient's sensitivity to certain medications, as well as previously demonstrated resistant strains, also contributes to the choice of antibiotic. As of 2003, an 0.3% topical solution of ofloxacin has been recommended as a more effective medication than other oral or topical antibiotics.
Some controversy exists regarding whether overuse of antibiotics is actually contributing to the development of bacteria, which may evolve and become able to avoid being killed by antibiotics. Research is being done to try to help determine whether there may be some ear infections that will clear up without antibiotic treatment. In the meantime, the classic treatment of an ear infection continues to involve a seven to 10-day course of antibiotic medication.
Some medical practitioners prescribe the use of special nosedrops, decongestants, or antihistamines to improve the functioning of the eustachian tube.
Whether or not antibiotics are used, such pain relievers as Tylenol or Motrin can be very helpful in reducing the pain and inflammation associated with otitis media.

Surgery

In a few rare cases, a surgical perforation to drain the middle ear of pus may be performed. This procedure is called a myringotomy. The hole created by the myringotomy generally heals itself in about a week. In 2002 a new minimally invasive procedure was introduced that uses a laser to perform the myringotomy. It can be performed in the doctor's office and heals more rapidly than the standard myringotomy.
Although some doctors have recommended removing the adenoids to prevent recurrent otitis media in young children, recent studies indicate that surgical removal of the adenoids does not appear to offer any advantages over a myringotomy as a preventive measure.

Alternative treatment

Some practitioners believe that food allergies may increase the risk of ear infections, and they suggest eliminating suspected food allergens from the diet. The top food allergens are wheat, dairy products, corn, peanuts, citrus fruits, and eggs. Elimination of sugar and sugar products can allow the immune system to work more effectively. A number of herbal treatments have been recommended, including ear drops made with goldenseal (Hydrastis canadensis), mullein (Verbascum thapsus), St. John's wort (Hypericum perforatum), and echinacea (Echinacea spp.). Among the herbs often recommended for oral treatment of otitis media are echinacea and cleavers (Galium aparine), or black cohosh (Cimicifuga racemosa) and ginkgo (Ginkgo biloba). Homeopathic remedies that may be prescribed include aconite (Acontium napellus), Ferrum phosphoricum, belladonna, chamomile, Lycopodium, pulsatilla (Pulsatilla nigricans), or silica. Craniosacral therapy uses gentle manipulation of the bones of the skull to relieve pressure and improve eustachian tube function.

Prognosis

With treatment, the prognosis for acute otitis media is very good. However, long-lasting accumulations of fluid within the middle ear are a risk both for difficulties with hearing and speech, and for the repeated development of ear infections. Furthermore, without treatment, otitis media can lead to an infection within the nearby mastoid bone, called mastoiditis.

Prevention

Although otitis media seems somewhat inevitable in childhood, some measures can be taken to decrease the chance of repeated infections and fluid accumulation. Breastfeeding provides some protection against URIs, which in turn protects against the development of otitis media. If a child is bottle-fed, parents should be advised to feed him or her upright, rather than allowing the baby to lie down with the bottle. General good hygiene practices (especially handwashing) help to decrease the number of upper respiratory infections in a household or daycare center.
The use of pacifiers should be avoided or limited. They may act as fomites, particularly in a daycare setting. In children who are more susceptible to otitis media, pacifier use can increase by as much as 50% the number of ear infections experienced.
Two vaccines can prevent otitis media associated with certain strains of bacteria. One is designed to prevent meningitis and other diseases, including otitis media, that result from infection with Haemophilus influenzae type B. Another is a vaccine against Streptococcus pneumoniae, a very common cause of otitis media. Children who are at high risk or have had severe or chronic infections may be good candidates for these vaccines; in fact, a recent consensus report among pediatricians recommended routine administration of the pneumococcal conjugate vaccine to children younger than two years, as well as those at high risk for AOM. Parents should consult a health care provider concerning the advisability of this treatment.
Another vaccine that appears to lower the risk of AOM in children is the intranasal vaccine that was recently introduced for preventing influenza. Although the flu vaccine was not developed to prevent AOM directly, one team of researchers found that children who were given the vaccine before the start of flu season were 43% less likely to develop AOM than children who were not vaccinated.
As of early 2003, there is no vaccine effective against M. catarrhalis. Researchers are working on developing such a vaccine, as well as a tribacterial vaccine that would be effective against all three pathogens that commonly cause otitis media.
A nutrition-based approach to preventive treatment is undergoing clinical trials as of late 2002. This treatment involves giving children a dietary supplement of lemon-flavored cod liver oil plus a multivitamin formula containing selenium. The pilot study found that children receiving the supplement had fewer cases of otitis media, and that those who did develop it recovered with a shorter course of antibiotic treatment than children who were not receiving the supplement.
After a child has completed treatment for otitis media, a return visit to the practitioner should be scheduled. This visit should occur after the antibiotic has been completed, and allows the practitioner to evaluate the patient for the persistent presence of fluid within the middle ear. In children who have a problem with recurrent otitis media, a small daily dose of an antibiotic may prevent repeated full attacks of otitis media. In children who have persistent fluid, a procedure to place tiny tubes within the eardrum may help equalize pressure between the middle ear and the outside, thus preventing further fluid accumulation.

Key terms

Adenoid — A collection of lymph tissue located in the nasopharynx.
Effusion — A collection of fluid which has leaked out into some body cavity or tissue.
Eustachian tube — A small tube which runs between the middle ear space and the nasopharynx.
Fomite — An inanimate object that can transmit infectious organisms.
Myringotomy — A surgical procedure performed to drain an infected middle ear. A newer type of myringotomy uses a laser instead of a scalpel.
Nasopharynx — The part of the airway into which the nose leads.
Ossicles — Tiny bones located within the middle ear which are responsible for conveying the vibrations of sound through to the inner ear.
Perforation — A hole.
Topical — Referring to a medication applied to the skin or outward surface of the body. Ear drops are one type of topical medication.

Resources

Books

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part I: Chiropractic and Osteopathy. New York: Simon & Schuster, 2002.

Periodicals

Abes, G., N. Espallardo, M. Tong, et al. "A Systematic Review of the Effectiveness of Ofloxacin Otic Solution for the Treatment of Suppurative Otitis Media." ORL 65 (March-April 2003): 106-116.
Bucknam, J. A., and P. C. Weber. "Laser Assisted Myringotomy for Otitis Media with Effusion in Children." ORL-Head and Neck Nursing 20 (Summer 2002): 11-13.
Cripps, A. W., and J. Kyd. "Bacterial Otitis Media: Current Vaccine Development Strategies." Immunology and Cell Biology 81 (February 2003): 46-51.
Decherd, M. E., R. W. Deskin, J. L. Rowen, and M. B. Brindley. "Bordetella pertussis Causing Otitis Media: A Case Report." Laryngoscope 113 (February 2003): 226-227.
Goodwin, J. H., and J. C. Post. "The Genetics of Otitis Media." Current Allergy and Asthma Reports 2 (July 2002): 304-308.
Hoberman, A., C. D. Marchant, S. L. Kaplan, and S. Feldman. "Treatment of Acute Otitis Media Consensus Recommendations." Clinical Pediatrics 41 (July-August 2002): 373-390.
Linday, L. A., J. N. Dolitsky, R. D. Shindledecker, and C. E. Pippinger. "Lemon-Flavored Cod Liver Oil and a Multivitamin-Mineral Supplement for the Secondary Prevention of Otitis Media in Young Children: Pilot Research." Annals of Otology, Rhinology, and Laryngology 111 (July 2002): 642-652.
Marchisio, P., R. Cavagna, B. Maspes, et al. "Efficacy of Intranasal Virosomal Influenza Vaccine in the Prevention of Recurrent Acute Otitis Media in Children." Clinical Infectious Diseases 35 (July 15, 2002): 168-174.
Mattila, P. S., V. P. Joki-Erkkila, T. Kilpi, et al. "Prevention of Otitis Media by Adenoidectomy in Children Younger Than 2 Years." Archives of Otolaryngology—Head and Neck Surgery 129 (February 2003): 163-168.
Menger, D. J., and R. G. van den Berg. "Pneumocystis carinii Infection of the Middle Ear and External Auditory Canal. Report of a Case and Review of the Literature." ORL 65 (January-February 2003): 49-51.
Redaelli de Zinis, L. O., P. Gamba, and C. Balzanelli. "Acute Otitis Media and Facial Nerve Paralysis in Adults." Otology and Neurotology 24 (January 2003): 113-117.
Weiner, R., and P. J. Collison. "Middle Ear Pathogens in Otitis-Prone Children." South Dakota Journal of Medicine 56 (March 2003): 103-107.

Organizations

American Academy of Otolaryngology, Head and Neck Surgery, Inc. One Prince Street, Alexandria, VA 22314-3357. (703) 836-4444.
American Academy of Pediatrics (AAP). 141 Northwest Point Boulevard, Elk Grove Village, IL 60007. (847) 434-4000. www.aap.org.
American Osteopathic Association (AOA). 142 East Ontario Street, Chicago, IL 60611. (800) 621- 1773. www.aoa-net.org.

otitis

 [o-ti´tis]
inflammation of the ear. adj., adj otit´ic.
aviation otitis a symptom complex due to difference between atmospheric pressure of the environment and air pressure in the middle ear; called also barotitis media.
otitis exter´na inflammation of the external ear, usually caused by a bacteria or fungus. See also otomycosis.
otitis externa, circumscribed acute bacterial otitis externa in a limited area, with formation of a furuncle that may obstruct the canal; usually due to a staphylococcal infection. Called also furuncular otitis externa.
otitis externa, diffuse otitis externa involving a relatively wide area, without formation of a furuncle.
otitis externa, furuncular circumscribed otitis externa.
otitis externa, malignant a progressive, necrotizing infection of the external auditory canal caused by Pseudomonas aeruginosa and affecting chiefly elderly diabetic and immunocompromised patients. It begins with the formation of granulation tissue in the external auditory canal, followed by localized chondritis and osteomyelitis, extension to the tissues surrounding the ear with destruction of involved bone, and involvement of the cranial nerves at the base of the skull; mortality in patients with nerve involvement is high.
furuncular otitis circumscribed otitis externa.
otitis inter´na labyrinthitis.
otitis me´dia inflammation of the middle ear, usually seen in infants and young children, and classified as either serous (or secretory) or suppurative (or purulent). Both types characteristically result in accumulations of fluid behind the tympanic membrane with some degree of hearing loss.
Serous Otitis Media. In this condition the eustachian tube fails to maintain equality of the barometric pressure within and outside the middle ear. When the tube fails to open and close as it should, air within the middle ear is under negative pressure. This causes inward retraction of the eardrum and movement of serous fluid from the mucosal capillaries into the middle ear space. The serous fluid can fill up the space and cause conductive hearing loss.

Acute serous otitis media usually follows an upper respiratory infection or trauma to the ear or may be associated with an allergy or enlarged adenoids. Symptoms are mild and may consist only of a feeling of fullness in the ear and some evidence of hearing loss. Otitis media with effusion is fluid in the middle ear with no signs or symptoms of infection.
Suppurative Otitis Media. The introduction of pus-producing bacteria into the middle ear causes this condition. It usually is associated with an upper respiratory infection, particularly when organisms from the nasopharynx find their way into the middle ear via the eustachian tube.

Symptoms include irritability, difficulty in sleeping, some pain, and loss of hearing. If sufficient pressure builds up behind the tympanic membrane it may rupture spontaneously and exude a purulent discharge. If the pus-laden fluid breaks through internally it can result in intracranial abscess, meningitis, and mastoiditis. Acute suppurative otitis media is treated aggressively with antibacterials and tympanocentesis to relieve pressure and obtain fluid for culturing. If the condition becomes chronic there is continuous otorrhea and hearing loss. Treatment includes systemic antibacterials, topical therapy with ear drops, tympanoplasty to repair a ruptured ear drum and damaged ossicles, and, sometimes, mastoidectomy to eliminate all sources of infection.
Otitis Media with Effusion. is fluid in the middle ear with no signs or symptoms of infection. management. The American Academy of Pediatrics has developed clinical guidelines called Managing Otitis Media With Effusion in Young Children. They recommend the use of pneumatic otoscopy to assess middle ear status and tympanometry. Children who have had fluid in both middle ears for a total of three months should undergo hearing evaluation. Observation or antibiotic therapy are treatment options if the effusion has been present for less than four to six months. Most cases of otitis media with effusion resolve spontaneously.

Three sets of guidelines are available: the aforementioned (AHCPR Publication 94-0623); Otitis Media with Effusion in Young Children (AHPCR Publication 94-0622); and Middle Ear Fluid in Children: Parent Guide (AHCPR Publication 94-0624). Copies can be obtained by writing the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907, calling 1-800-358-9295, or consulting their web site at http://www.ahcpr.gov.

o·ti·tis me·'di·a

inflammation of the middle ear, or tympanum.

otitis media

n.
Inflammation of the middle ear, occurring commonly in children as a result of infection and often causing pain and temporary hearing loss.

otitis media

an inflammation or infection of the middle ear, common in early childhood. Acute otitis media is most often caused by Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae. Chronic otitis media is usually caused by gram-negative bacteria such as Proteus, Klebsiella, and Pseudomonas. Allergy, Mycoplasma, and several viruses also may be causative factors. Otitis media is often preceded by an upper respiratory infection.
observations Organisms gain entry to the middle ear through the eustachian tube. The small diameter and horizontal orientation of the tube in infants predisposes them to infection. Obstruction of the eustachian tube and accumulation of exudate may increase pressure within the middle ear, forcing infection into the mastoid bone or rupturing the tympanic membrane. Symptoms of acute otitis media include a sense of fullness in the ear, diminished hearing, pain, and fever. Usually only one ear is affected. Squamous epithelium may grow in the middle ear through a rupture in the tympanic membrane; development of a cholesteatoma and hearing loss may occur if repeated infections cause an opening to persist. Pneumococcal otitis media may spread to the meninges.
interventions Treatment includes antibiotics, analgesics, local heat, nasal decongestants, needle aspiration of secretions collected behind the membrane, and myringotomy.
nursing considerations Parents are taught to recognize and watch for early warning signs of otitis media. The use of vaporizers and decongestants is often recommended during an upper respiratory tract infection as prophylaxis against otitis media. Chronic otitis media may result in hearing loss and delays in speech development.
enlarge picture
Otitis media

middle ear infection

A condition characterised by inflammation, fluid overproduction (which may rupture the tympanic membrane, providing a portal of entry for bacteria and viruses), purulence and bleeding. MEI is more common in children, as their eustachian tubes are shorter, narrower and more horizontal than adults.
 
Risk factors
Infections, sinusitis, allergy-induced eustachian tube blockage or adenoidal enlargement, recent illness (lowered resistance), crowding, poor hygiene, heredity, high altitude, cold climate, bottle feeding (with pooling of fluid at the eustachian tube).

otitis media

ENT Middle ear inflammation, most common in young children, often due to infection Clinical Bulging, discolored tympanic membrane with ↓ motility, ear pain, irritability, difficulty in sleeping and eating, fever, vomiting DiffDx Abscesses, furuncles, foreign bodies, mumps, external otitis, toothache Risk factors UTIs, rhinitis, trisomy 21, other trisomies, cystic fibrosis, hypothyroidism, passive smoking, day care centers Management Amoxicillin; T-S for resistant bacteria. See Acute otitis media, Secretory otitis media.

o·ti·tis me·di·a

(OM) (ō-tī'tis mē'dē-ă)
Inflammation of the middle ear, or tympanum.

otitis media

Inflammation in the middle ear cavity. This usually results from spread of infection from the nose or throat by way of the EUSTACHIAN TUBE. In acute suppurative otitis media there is rapid production of pus with a pressure rise that causes the eardrum to bulge outwards. In chronic suppurative otitis media, there is a hole (perforation) in the drum and usually a persistent discharge (otorrhoea). Secretory otitis media, or ‘glue ear’, is persistent and insidious and mainly affects children causing unsuspected deafness and educational disadvantage. All forms of otitis media respond well to expert treatment. Glue ear is usually treated by the insertion of grommets in the drum to promote middle ear drainage.

otitis media,

o·ti·tis me·di·a

(OM) (ō-tī'tis mē'dē-ă)
Inflammation of the middle ear, or tympanum.

otitis

inflammation of the ear.

ceruminous otitis
that in which there is excessive cerumen and a characteristic rancid odor.
otitis externa
inflammation of the external ear characterized by frequent shaking of the head, pawing at the ear, intermittent rotation of the head with the affected ear down, pain on palpation of canal, bad odor and discharge. Called also swimmer's ear.
furuncular otitis
the formation of furuncles in the external acoustic meatus.
otitis interna
labrynthitis; usually due to an extension of otitis media. Clinical signs include varying degrees of peripheral vestibular dysfunction. Deafness may also occur. Called also otitis labyrinthica.
otitis labyrinthica
see otitis interna (above).
otitis media
inflammation of the middle ear. It may occur in young animals by hematogenous spread of infection from omphalophlebitis, but it may also arise from extension of otitis externa or by infection ascending the eustachian tube. Clinical signs are usually referable to an associated otitis externa (odor, discharge, pain) or otitis interna which may cause vestibular signs such as rolling, ataxia and nystagmus. In addition, inflammation of the middle ear may cause facial paralysis, Horner's syndrome or keratitis sicca.
parasitic otitis
References in periodicals archive ?
2) Physical examination may detect some granulation or polyps over the external auditory canal, middle ear cavity, and/or mastoid area, similar to what is observed in chronic otitis media caused by common pathogens.
9 years) with diagnoses of otitis media who formed the study group, while 25 healthy subjects (13 males and 12 females; mean age: 7.
Mastoiditis has become relatively rare, with antibiotic treatment of otitis media.
Medicines such as antihistamines and decongestants do not help in the prevention or treatment of otitis media.
Essentially all cases of otitis media require medical evaluation and intervention.
The databook offers a preliminary coverage of disease clinical trials by their phase, trial status, prominence of the sponsors and also provides briefing pertaining to the number of trials for the key drugs for treating Otitis Media.
The burden and population demographics of otitis media differ greatly between developed and developing regions.
1) Clinical manifestations of such include otitis media and Bell palsy.
London, Feb 18 (ANI): Consumption of zinc supplements may not necessarily cut down risk of middle ear infections or otitis media among children, a new study claims.
Researchers report in this issue that young children exposed to higher levels of traffic pollution have a greater incidence of otitis media (middle ear infections) than those exposed to lower levels [EHP 114:1414-1418; Brauer et al.
We investigated the association between prescribing antimicrobial agents and antimicrobial resistance of Streptococcus pneumoniae among children with acute otitis media in southern Israel.