Otitis media

From Wikimd

Otitis media (also known as glue ear) is an inflammation of the middle ear segment of the ear. It is usually associated with a buildup of fluid and frequently causes an earache. The fluid may or may not be infected.

Types

There are several kinds of otitis media:

1. Acute otitis media is an infection that produces pus, fluid, and inflammation within the middle ear. It is frequently associated with signs of upper respiratory infection, such as a runny nose or stuffy nose. It is often associated with Mastoiditis.
2. Otitis media with effusion is the presence of middle ear fluid for six weeks or more from the initial acute otitis media.
3. Chronic otitis media may develop when the infection persists for more than two weeks.
4. "Adhesive Otitis Media"

Progression

The typical progress of otitis media is: the tissues surrounding the Eustachian tube swell due to an infection and/or severe congestion. The Eustachian tube remains blocked most of the time. The air present in the middle ear is slowly absorbed into the surrounding tissues. A strong negative pressure creates a vacuum in the middle ear. The vacuum reaches a point where fluid from the surrounding tissues accumulates in the middle ear. This is seen as a progression from a Type A tympanogram, to a Type C, to a Type B tympanogram. The fluid may become infected. It has been found that dormant bacteria behind the Tympanum (eardrum) multiply when the conditions are ideal infecting the middle ear fluid.

Causes

Streptococcus pneumoniae,Moraxella catarrhalis, and Haemophilus influenzae are the most common bacterial causes of otitis media. Tubal dysfunction leads to the ineffective clearing of bacteria from the middle ear.

As well as being caused by the already mentioned bacteria, it can also be caused by the common cold.

Due to the advent of the Haemophilus influenzae vaccine, it is now a much less common etiologic cause for infection, not just for acute otitis media, but for other entities such as epiglotitis.

Susceptibility in children

Children below the age of seven years are much more prone to otitis media since the Eustachian tube is shorter and at a different angle than that of the adult ear. They also have not developed the same resistance to viruses and bacteria as adults.

Treatment

Whilst antibiotics were previously routinely immediately started, there is poor evidence as to their efficacy at shortening disease duration compared to the illness's natural history in the majority of children.

Protocols now exist for deferring the start of antibiotics for up to 72 hours.

This results in 2 out of 3 children avoiding the need to start antibiotics and no adverse effect on longterm outcomes for those whose treatment is deferred.

In chronic cases or with effusions present, surgery is sometimes performed to insert a grommet (called a "tympanostomy tube") into the eardrum to allow air to pass through into the middle ear, and thus release any pressure buildup and help clear excess fluid within.

External links

• What is otitis media?
• Acute otitis media in children
• eMedicine
• NIH

Modified from Wikipedia's article licensed under GNU FDL