Otitis

Otitis Media
Media

By
James A. Yost, M.D., MS, M.B.A.
Emory Family Medicine
 Otitis Media

•Definition
•Epidemiology
• Acute •Risk Factors
•Microbiology
• Chronic •Complications
•Diagnosis
•Treatment
 Otitis Media
• Otitis
– Gr. otos, ear, + itis, inflammation
• Media
– Referrs to the middle portion of the ear
• Definition
– any inflammation of the middle ear
without reference to etiology or
pathogenesis
Acute Otitis Media
 Acute Otitis Media
• Definition
– Onset less than 3 weeks
• Epidemiology
– In the U.S. 20,000,000 cases of AOM are
estimated to occur each year.
– By age 12 months, 66% of all children have
had at least one episode of AOM
– By age 3 years, 46% of children had 3 or
more episodes of AOM
 Acute Otitis Media
• Epidemiology cont.
– 2nd most common disease of Childhood
– the most common cause for childhood visits
to a physician's office
– Highest incidence of AOM occurs between
6 and 24 months of age
– much less common after 7 years of age
 Acute Otitis Media
• Risk Factors
– Day care
– Winter months
– Craniofacial anomalies
– Congenital or acquired immune
dysfunction
– Eustachian tube dysfunction
– Ciliary dysfunction
– Allergies
– Cigarette smoke and air pollution
– Nasal obstruction
Acute Otitis Media
Bugs!!
• Bacteria
– S. pneumoniae (35%)
– H. influenzae (25%)
– M. catarrhalis (15%)
– Gram negative enteric bacteria (25%)
• Viruses
– Respiratory syncytial virus
– Adenovirus
– Rhinovirus
– Influenza virus
 Acute Otitis Media
• Complications
– Persistent middle ear effusions

• 40% have effusion at one month

• 20% at two months

• 10% at three months

– Hearing loss (conductive and sensory)
– TM perforation
 Acute Otitis Media
• Complications cont.
– Chronic suppurative otitis media
– Atelectasis
– Cholesteatoma
– Tympanosclerosis
– Mastoiditis
– Meningitis
– Labyrinthitis
 Acute Otitis Media
• Diagnosis
– Otalgia

– Ear tugging

– Otorrhea

– Hearing loss

– Fever, irritability, anorexia, N/V, diarrhea,

lethargy, headache

– Tinnitus, vertigo
 Acute Otitis Media

• Diagnosis cont.
– Physical exam with an otoscope:
• Opacity
• Bulging TM
• Erythema
• Middle ear effusion (MEE)
• Decreased mobility with pneumatic otoscopy
Acute Otitis Media
Acute Otitis Media
Acute Otitis Media
Acute Otitis Media
 Acute Otitis Media
• Treatment
– The ABCDEFs of treating AOM
• Amoxicillin/Augmentin
• Biaxin/Bactrum
• Cephalosporins
• Diet/hydration
• Erythromycin
• Fever control
 Chronic Otitis Media
• Definition
– Greater than 3 months
– Chronic serous otitis media may be
defined as a middle ear effusion, having
the nature of serum
– Chronic suppurative otitis media is a
middle ear effusion having an agent
producing pus formation
 Chronic Otitis Media
• Epidemiology
– 39 cases per 100,000 persons in
children and adolescents aged 15 years
and younger
– 8% of American Indians
– 12% of Eskimos
Chronic Otitis Media
• Risk Factors
– A history of multiple episodes of AOM
– Living in crowded conditions
– Day care facility attendance
– Being a member of a large family
– Ciliary dysfunction
– Chronic Allergies
– Cigarette smoke and air pollution
– Nasal obstruction from adenoids
 Chronic Otitis Media
• Bacteria
– P. aeruginosa (40%)
– S. aureus (20%)
– Klebsiella (20%)
– Anaerobes are found in 50% of cases
 Chronic Otitis Media
• Diagnosis
– A common presenting complaint is hearing
loss in the affected ear
– Fever or vertigo
– The external auditory canal may or may not
be edematous and typically is not tender.
– The discharge of purulent, and cheeselike to
clear and serous.
 Chronic Otitis Media
• Diagnosis cont.
– Granulation tissue often is seen
– The middle ear mucosa may be
edematous or even polypoid, pale, or
erythematous.
– CT scan or MRI
Chronic Otitis Media
Chronic Otitis Media
 Chronic Otitis Media
• Treatment
– Chemoprophylaxis
– Myringotomy and tubes:
• 4 episodes of AOM in six months
• 6 episodes a year
• Or no response to treatments
– Adenoidectomy
– Pneumococcal vaccines
 Chronic Otitis Media
• Treatment cont.
– Topical antibiotic drops containing
aminoglycosides
– Intranasal or systemic decongestants
– Systemic antihistamines
– Systemic or intranasal steroids
Chronic Otitis Media
Chronic Otitis Media
 Chronic Otitis Media

• Myringotomy tubes.wmv
Click here for a video of a myringotomy