Otitis Media

Otitis Media
Presentation by:Rick Newton, MD

Definition:inflammation of the middle ear

Why the Worry?
* Ear Pain
* Possible Complications
o Hearing Loss (esp. conductive)
+ Leading to speech, language, and cognitive abilities
o Ruptured TM
o Mastoiditis
o Meningitis
o Labyrinthitis
o Brain Abcess
o Lemierre’s Syndrome - anaerobic suppurative thrombophlebitis involving the internal jugular vein

Epidemiology
Risk Factors
Pathogenesis
* Typically follows URI or Allergy
* Congestion obstructs eustachian tube @ isthmus.
* Middle ear secretions accumulate
* Normal flora or new infections in upper respiratory tract to middle ear.

Bacteriology
3 bacteria remain most common isolates even in post-PCV7 & HIB vaccine era
Strep. pneumoniae
Haemophilus Influenzae
Moraxella catarrhalis


Symptoms/Signs
Otalgia
Otorrhea
Non-specific

o Fever
o Irritability
o HA
o Apathy
o Anorexia
o Vomiting
o diarrhea

Syndromes: Otitis-Conjunctivitis

* Symptom complex of otitis media and purulent conjunctivitis
* Classically nontypable H. influenzae (54% of all cases)
* inflammation of the TM in which bullae are present on the tympanic membrane
* occurs in ~ 5 percent of cases of AOM in children younger than 2 years
* Characterized by increased pain

Syndromes: Bullous Myringitis
Virology
* RSV
* Rhinoviruses
* Influenza

Other Microbes
* Mycoplasma pneumonniae
* Chlamydia trachomatis
* Tuberculous
* Ascaris lumbricoides
* Blastomyces dermatitidis
* Candida
* Aspergillus

Diagnosis

* Two diagnostic criteria for AOM
o Inflammation
o Fluid in middle ear
* Otoscopy
o TM erythematous, bulging, and immobile
* Techniques to Confirm Dx
o Pneumatic Otoscopy
o Culture

AAP Consensus Dx Criteria:
Nature of the Illness
Antibiotics & Otitis Media
The Controversy
Treatment Options
When to Consider Tympanostomy Tubes or Chemoprophylaxis
Tympanostomy Tubes
Complications of Tympanostomy Tubes
To Swim or Not to Swim
Management of Patients with Tympanostomy Tubes
* Otorrhea
* Tube Extrusion
* Cholesteatoma
* Persistent TM Perforation
* Tympanosclerosis

Otitis Media.ppt