OTITIS MEDIA - Disease Management

It is a bacterial or viral infection in the middle ear, usually secondary to an upper respiratory tract infection (URTI). Although acute otitis media can occur at any age, it is most common in young children, particularly from age 3 mo to 3 yr. Microorganisms may migrate from the nasopharynx to the middle ear by moving over the surface of the Eustachian tube's mucous membrane or by propagating in the lamina propria of the mucous membrane as spreading cellulitis or thrombophlebitis.

Causes

In newborns

• Gram-negative enteric bacilli, Escherichia coli, Staphylococcus aureus

After the neonatal period

• E. coli rarely cause acute otitis media. In older infants and children< 14 yr: Streptococcus pneumoniae, Haemophilus influenzae, group A B-hemolytic streptococci, Moraxella (Branhamella) catarrhalis, and S. aureus
• Viral otitis media is usually complicated by secondary invasion by one of these bacteria. In those > 14 yr, S. pneumoniae, group A
• B-hemolytic streptococci, S. aureus, H.influenzae.

Risk Factors

• Daycare
• Formula feeding
• Passive smoking
• Male
• Family history of middle ear disease
• Acute otitis media in the first year of life is a risk factor for recurrent acute otitis media

Signs and Symptoms

• Severe earache
• Hearing loss
• Fever (up to 40.50°C [105.0°FI)
• Nausea and vomiting
• Diarrhea
• Bulged erythematous tympanic membrane
• Serosanguineous
• Purulent otorrhea

DIAGNOSIS

Differential Diagnosis

• Referred pain from the jaw or teeth

Investigations

• Tympanometry
• Acoustic reflectometry
• Hearing testing
• Tympanocentesis
• Nasopharyngeal cultures

TREATMENT

Goal

• To relieve symptoms
• Hasten resolution of the infection
• Reduce the chance of labyrinthine and intracranial infectious
• Reduce the complications and residual damage to the hearing mechanism in the middle ear.

Pharmacological Treatment

Antibiotic therapy

• 1st line agents: Amoxicillin, co-trimoxazole, erythromycin
• 2nd line agents: Amoxicillin/clavulanate, cefdinir, cefpodoxime, cefuroxime axetil, clarithromycin
• 3rd line agents: Ceftriaxone, clindamycin, levofloxacin

Surgical Treatment

Myringotomy should be considered if the tympDanie the membrane has bulged or it pain, fever, vomiting, and diarrhea are severe or persistent.

Complications

• Acute mastoiditis
• Petrositis
• Hearing loss
• Labyrinthitis
• Cholesteatoma
• Facial paralysis
• Conductive and sensorineural hearing loss
• Epidural abscess
• Atrophy and scarring of eardrum, chronic perforation, and otorrhea
• Meningitis, brain abscess, lateral sinus thrombosis, subdural empyema, and otitic hydrocephalus.

Prognosis

Symptoms of otitis media usually improve in 48-72hrs; otitis media with effusion following acute otitis media resolved in 90% by 3 months. Otitis media with effusion have a lesser percentage of complications.