Otitis Media

Otitis Media
Presentation by:Lawrence D. Beem, D.C., FICPA
Cleveland Chiropractic College
Assistant Professor: Pediatrics

Otitis Media
* Otitis Media is the second most common reason after a well baby visit to the pediatrician’s office.
* It is estimated that approximately 30 million office visits per year involve evaluation and treatment of Otitis Media and billions of dollars are spent annually for Otitis Media care.
* More than a quarter of all prescriptions written each year for oral antibiotics are for the treatment of middle ear infections.
* Many surgical procedures such as myringotomy with tympanostomy tube placement or tonsillectomy and adenoidectomy are preformed on children for treatment of recurrent diseases.

Otitis Media Classifications

* OM can be classified into 4 categories:
o Acute Otitis Media is the sudden onset of inflammation of the middle ear, which is often accompanied by fever and ear pain.
o Persistent Middle Ear Effusion also called subacute OM, is the presence of middle ear fluid after antimicrobial treatment. Resolution of acute inflammatory signs has occurred, with persistence of a more serous, less purulent effusion.
o Recurrent Otitis Media is frequent episodes of acute OM with complete clearing between each case. This condition affects approximately 20% of the children who are (Otitis Prone), such children are usually infants who have their 1st. Infection at less than a year of age.
o Chronic Otitis Media with effusion, (serous OM, secretory OM,) is a chronic condition characterized by persistence of fluid in the middle ear for 3 months or longer. The TM is retracted or concave with impaired mobility and shows no signs of acute inflammation and affected children may be asymptomatic. These individuals are at greatest risk for developing hearing deficits and speech delay.

Otitis Media Epidemiology

* Peak incidence is 6 to 36 months of age.
* OM is relative uncommon in older children and adolescents.
* The condition is more common in boys and the prevalence is greater in Alaskan natives, Native Americans, and Caucasians.
* Epidemiologic Risk Factors:
o Familial predisposition
o low socioeconomic status
o altered host defences
o environmental factors
o presence of underlying condition
* The highest rate of Otitis Media occurs during the winter months and early spring, coinciding with peaks in the incidence of URI’s.
* Breast feeding which provides infants with immunologic protection against URI’s, other viral and bacterial infections and allergies, is thought to have a preventive effect against OM.
* I has been hypothesized that facial muscles develop differently in breast-fed infants, thus influencing eustachian tube function and preventing aspiration of fluid into the middle ear.Positioning during breastfeeding also has been hypothesized to have some protective effect.

Diagnosis (Otitis Media)

* Ear pain or otorrhea
* Possibly fever
* Abnormal tympanic membrane
* Erythema or injection of tympanic
* Pus behind the tympanic membrane
* Bulging appearance
* Distorted or absent light reflex
* Decreased mobility via pneumatic otoscopy

Pathophysiology (OM)

* The most important factor in the pathogenesis OM is abnormal function of the eustachian tube.
* Reflux, aspiration or insufflation of nasopharyngeal bacteria into the middle ear via the dysfunctional eustachian tube may lead to infection.
* The causative microorganisms for OM are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
* Group A streptoccus, Staphylococcus aureus, and anaerobic bacteria are other less common causes.
* Eustachian tube dysfunction occurs primarily for 2 reasons: abnormal patency and obstruction.
* Obstruction is either functional or mechanical or both.
o Functional, secondary to collapse of the eustachian tube, obstruction or collapse of the eustachian tube occurs commonly in infants and young children because the tube is less cartilaginous and therefore less stiff than in adults.
o Intrinsic mechanical obstruction of the eustachian tube occurs as the result of inflammation secondary to a URI or allergy.
o Extrinsic causes of mechanical obstruction include masses such as tumors or adrenoidal enlargement.
* Differential Diagnosis:
o The most common cause of otalgia, or ear pain, is acute OM.
o Other causes include mastoiditis, which is almost always accompanied by OM; otitis externa; and referred pain from the oropharynx, teeth, adenoids, or posterior auricular lymph nodes.
o A foreign body in the canal can produce similar symptoms.

Ant in Ear
Ear tick
Bug in Ear
Leach in Ear

Physical Examination
Indications For Tympanocentesis or Myringotomy
Management

Otitis Media.ppt