Introduction post

Welcome to our modest webpage, otitis media, where we strive to provide educational content in the form of interesting informatics that is concise, precise, and easily accessible.

We will be setting the niche to otitis media, the infection of the middle ear, a silent, unassuming culprit to many auditory systemic complications. 

We hope that you do enjoy the content provided, and that we are able to disseminate new information that increases awareness and helps more people. do provide feedback on any improvements that can be made to better cater to your needs, and compliments on a job well-done are very much welcomed too!

OTITIS MEDIA

Definition

  • an infection of the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear.
  • Children are more likely than adults to get ear infections. 🧒

Classification

Otitis media can be classified into two main types: acute otitis media (AOM) and chronic otitis media with effusion (OME).

  • Acute otitis media (AOM); characterized by the rapid onset of signs and symptoms of middle ear infection. It is often preceded by an upper respiratory tract infection, such as a cold. Common symptoms of AOM include ear pain, headache, impaired hearing, fluid drainage from the ear, fever, and irritability.
  • Chronic otitis media with effusion (OME); occurs when fluid remains trapped in the middle ear for an extended period, even after the initial infection has resolved. It is typically not associated with acute symptoms like pain or fever. OME may persist for weeks or months, particularly in children. OME often follows an episode of AOM. Symptoms that may be indicative of OME include hearing loss, tinnitus, vertigo, and ear pain. It is also often seen as a result of repeated episodes of AOM or as a complication of allergies or eustachian tube dysfunction.

Acute otitis media with purulent effusion behind a bulging tympanic membrane.
Chronic otitis media with a retraction pocket of the pars flaccida.

Etiology

  • Otitis media often occurs as a result of infection caused by bacteria or viruses.
    • The most common bacterial pathogen in AOM is Streptococcus pneumoniae, followed by non-typeable Haemophilus influenzae and Moraxella catarrhalis.
    • These three organisms are responsible for more than 95% of all AOM cases with a bacterial etiology.
       



  • Acute viral upper respiratory infection is a prominent risk factor for AOM development. 
    • Most investigators have suspected a role for respiratory viruses in AOM pathogenesis.
    • The viruses most commonly associated with AOM are :
      • Respiratory syncytial virus (RSV)
      • Influenza viruses
      • Parainfluenza viruses
      • Rhinovirus
      • Adenovirus.  
              

Pathogenesis

  • Upper respiratory tract infection: The pathogenesis of otitis media often begins with a viral or bacterial upper respiratory tract infection, such as a cold or flu. The infection can cause inflammation and swelling in the lining of the upper respiratory tract, including the Eustachian tube, which connects the middle ear to the back of the throat.
  • Eustachian tube dysfunction: Inflammation and swelling of the Eustachian tube can cause it to become blocked or partially blocked. This can lead to a build-up of fluid in the middle ear, as the normal drainage of fluid from the middle ear is impaired.
  • Bacterial colonization: The stagnant fluid in the middle ear can provide a breeding ground for bacteria, particularly if the fluid is not able to drain properly. Common bacteria that can cause otitis media include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
  • Infection of the middle ear: If bacteria are able to colonize the middle ear, they can cause an infection. This can lead to inflammation of the middle ear, which can be painful and cause further fluid accumulation.
  • Increased pressure: The inflammation and fluid accumulation can cause increased pressure in the middle ear. This can cause pain and discomfort, and can also lead to damage to the structures of the middle ear, such as the eardrum.
  • Spreading of infection: In severe cases, the infection can spread beyond the middle ear to other structures of the ear, such as the inner ear or the mastoid bone. This can cause serious complications, such as hearing loss or meningitis.
Overall, the pathogenesis of otitis media is complex and can be influenced by a variety of factors, including age, immune function, and exposure to pathogens. Effective treatment and prevention strategies typically involve addressing underlying risk factors, such as improving upper respiratory tract health and promoting good hygiene practices.

Clinical Manifestation

General symptoms include:

 

  • Fever (due to infection)

        

  • Earache (patient may describe this as a throbbing pain

         

  • Hearing loss in the affected ear

       

  • Complications include rupture of the tympanic membrane, which can lead to otorrhea (liquid from the ear) 

       

In infants specifically, because it is difficult for them to communicate, parents will complain of: 



  • Incessant crying 

  • Refusing to ear 

  • Irritability 

  • Vomiting 

  • Fever 


Upon examination by otoscopy 



  • Bulging tympanic membrane 

  • Erythematous tympanic membrane

  • Loss of light reflex, opacification 


Tuning fork test may be done; Weber and Rinne test can be done to verify complaint of conductive hear loss.

Complications

The pathogenesis of otitis media can lead to several complications, which may arise from the inflammation, pressure, and infection in the middle ear. Here's how;


  1. Hearing loss: The accumulation of fluid and inflammation in the middle ear can cause conductive hearing loss, which means that sound waves cannot travel effectively from the outer ear to the inner ear. This type of hearing loss is usually temporary and can be improved with treatment, but if left untreated, it can become permanent.


  1. Perforation of the eardrum: If the pressure in the middle ear becomes too great, it can cause the eardrum to rupture or perforate. This can cause pain and discomfort, as well as a discharge of fluid or pus from the ear. In some cases, the perforation may heal on its own, but in other cases, surgical intervention may be required.


  1. Mastoiditis: The infection in the middle ear can spread to the mastoid bone, which is located behind the ear. This can cause mastoiditis, which is an inflammation and infection of the bone. Mastoiditis can be serious and may require hospitalization and intravenous antibiotics.



  1. Meningitis: In rare cases, the infection in the middle ear can spread to the meninges, which are the membranes that surround the brain and spinal cord. This can cause meningitis, which is a serious and potentially life-threatening condition. Symptoms of meningitis can include headache, fever, and stiffness of the neck.


  1. Cholesteatoma: A chronic infection or perforation of the eardrum can lead to the formation of a cholesteatoma, which is an abnormal growth of skin cells in the middle ear. Cholesteatomas can cause hearing loss, dizziness, and facial paralysis, and may require surgical intervention.


Overall, the complications of otitis media can be serious and may require prompt diagnosis and treatment to prevent long-term damage to hearing and other structures of the ear.

Treatment and Management

Treatment

Aim of treatment: pain management and treat infection with antibiotics
  1. Analgesia: Only given as needed. The most common analgesia given is acetaminophen and ibuprofen.
  2. Antibiotic Therapy: Depends on clinical features and the age of the patient
  3. Screening: Screen patient for any complications, such as mastoiditis, tympanic membrane rupture or labyrinthithitis. 


Management

Conservative management : Due to the fact that uncomplicated acute otitis media is self-limiting in most children, conservative management is an option (for those >2 years old) 

Resources

  1. Acute otitis media - Knowledge @ AMBOSS. (2023, May 9). Acute Otitis Media - Knowledge @ AMBOSS. https://www.amboss.com/us/knowledge/acute-otitis-media                                                       
  2. Acute otitis media. ( April 15, 2023 ) National Library of Medicine, Natiknal Center for Biotechnology Information. https://www., ne rupbi.nlm.nih.gov/books/NBK470332/ 

  3. M. (n.d.). Ear infection (middle ear)-Ear infection (middle ear) - Symptoms & causes - Mayo Clinic. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616

  4. Otitis Media: Practice Essentials, Background, Pathophysiology. (2023, June 7). Otitis Media: Practice Essentials, Background, Pathophysiology. https://emedicine.medscape.com/article/994656-overview

  5. Acute Otitis Media: Pathogenesis and Clinical Findings (in Children) | Calgary Guide. (2014, September 16). The Calgary Guide to Understanding Disease. https://calgaryguide.ucalgary.ca/acute-otitis-media-pathogenesis-and-clinical-findings-in-children/

  6. Could Your Child Have Fluid in Their Ears? (2023, June 11). Verywell Health. https://www.verywellhealth.com/serous-otitis-media-1192122 

  7. Danishyar, A., & Ashurst, J. V. (2023, April 15). Acute Otitis Media - StatPearls - NCBI Bookshelf. Acute Otitis Media - StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470332/#:~:text=Otitis%20media%20begins%20as%20an,ear%20mucosa%2C%20and%20Eustachian%20tubes.



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