Acute otitis media

Otitis media is a group of inflammatory diseases of the middle ear. The two main types are acute otitis media (AOM) and otitis media with effusion (OME). AOM is an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. OME is typically not associated with symptoms. Occasionally a feeling of fullness is described. It is defined as the presence of non-infectious fluid in the middle ear for more than three months. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in discharge from the ear for more than three months. It may be a complication of acute otitis media. it is an infection commonly associated with a poor socio-economic status including factors such as malnutrition, poor hygiene, frequent upper respiratory tract infections and under-resourced healthcare. Pain is rarely present. CSOM can also be understood as a stage of an ear disease which involves chronic infection in the middle ear cleft such as Eustachian tube, middle ear, mastoid and a non-intact tympanic membrane (for example, a perforation of the tympanic membrane or a tympanostomy tube which is a small tube inserted into the eardrum), otorrhoea is also present.the perforations may also result as a sequelae of acute otitis media, and removal or trauma to the tympanostomy tube. from prevalence surveys they have shown that the global burden of illnesses from CSOM involves 65-330 million persons with ears that drain, and out of them 60% are diagnosed with a significant hearing loss which vary in severity.All three types of otitis media may be associated with hearing loss. The hearing loss in OME, due to its chronic nature, may affect a child's ability to learn.Acute otitis mediaAcute otitis media, myringitis bullosaMyringitis bullosa in influenzaChronic otitis media (otitis media chronica mesotympanalis)Otitis media chronica mesotympanalisOtitis media chronica mesotympanalisOtitis media chronica mesotympanalis Otitis media is a group of inflammatory diseases of the middle ear. The two main types are acute otitis media (AOM) and otitis media with effusion (OME). AOM is an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. OME is typically not associated with symptoms. Occasionally a feeling of fullness is described. It is defined as the presence of non-infectious fluid in the middle ear for more than three months. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in discharge from the ear for more than three months. It may be a complication of acute otitis media. it is an infection commonly associated with a poor socio-economic status including factors such as malnutrition, poor hygiene, frequent upper respiratory tract infections and under-resourced healthcare. Pain is rarely present. CSOM can also be understood as a stage of an ear disease which involves chronic infection in the middle ear cleft such as Eustachian tube, middle ear, mastoid and a non-intact tympanic membrane (for example, a perforation of the tympanic membrane or a tympanostomy tube which is a small tube inserted into the eardrum), otorrhoea is also present.the perforations may also result as a sequelae of acute otitis media, and removal or trauma to the tympanostomy tube. from prevalence surveys they have shown that the global burden of illnesses from CSOM involves 65-330 million persons with ears that drain, and out of them 60% are diagnosed with a significant hearing loss which vary in severity.All three types of otitis media may be associated with hearing loss. The hearing loss in OME, due to its chronic nature, may affect a child's ability to learn. The cause of AOM is related to childhood anatomy and immune function. Either bacteria or viruses may be involved. Risk factors include exposure to smoke, use of pacifiers, and attending daycare. It occurs more commonly among Indigenous peoples and those who have Down syndrome. OME frequently occurs following AOM and may be related to viral upper respiratory infections, irritants such as smoke, or allergies. Looking at the eardrum is important for making the correct diagnosis. Signs of AOM include bulging or a lack of movement of the tympanic membrane from a puff of air. New discharge not related to otitis externa also indicates the diagnosis. A number of measures decrease the risk of otitis media including pneumococcal and influenza vaccination, breastfeeding, and avoiding tobacco smoke. The use of pain medications for AOM is important. This may include paracetamol (acetaminophen), ibuprofen, benzocaine ear drops, or opioids. In AOM, antibiotics may speed recovery but may result in side effects. Antibiotics are often recommended in those with severe disease or under two years old. In those with less severe disease they may only be recommended in those who do not improve after two or three days. The initial antibiotic of choice is typically amoxicillin. In those with frequent infections tympanostomy tubes may decrease recurrence. In children with otitis media with effusion antibiotics may increase resolution of symptoms, but may cause diarrhoea, vomiting and skin rash. Worldwide AOM affects about 11% of people a year (about 325 to 710 million cases). Half the cases involve children less than five years of age and it is more common among males. Of those affected about 4.8% or 31 million develop chronic suppurative otitis media. Before the age of ten OME affects about 80% of children at some point. Otitis media resulted in 3,200 deaths in 2015 – down from 4,900 deaths in 1990. Prevalence of otitis media among children is also very important. Studies were conducted in primary healthcare clinics in South Africa with 140 children aged 2-16 years. Ceruman removal was necessary in 36% of the participants. Otitis media with effusion was the most frequent diagnosis with 16.5%, and 1.7% of them were diagnosed with acute otitis media in he 2-5 year age group. Otitis media was more prevalent in younger children than older children. Diagnosing otitis media at a younger age, makes it easier to manage and treat. This reduces the chances of otitis media getting more severe and from it becoming chronic, which have severe consequences. An integral symptom of acute otitis media is ear pain; other possible symptoms include fever, and irritability (in infants). Since an episode of otitis media is usually precipitated by an upper respiratory tract infection (URTI), there are often accompanying symptoms like a cough and nasal discharge. Discharge from the ear can be caused by acute otitis media with perforation of the ear drum, chronic suppurative otitis media, tympanostomy tube otorrhea, or acute otitis externa. Trauma, such as a basilar skull fracture, can also lead to discharge from the ear due to cerebral spinal drainage from the brain and its covering (meninges). The common cause of all forms of otitis media is dysfunction of the Eustachian tube. This is usually due to inflammation of the mucous membranes in the nasopharynx, which can be caused by a viral URTI, strep throat, or possibly by allergies. Because of the dysfunction of the Eustachian tube, the gas volume in the middle ear is trapped and parts of it are slowly absorbed by the surrounding tissues, leading to negative pressure in the middle ear. Eventually, the negative middle-ear pressure can reach a point where fluid from the surrounding tissues is sucked into the middle ear's cavity (tympanic cavity), causing a middle-ear effusion. This is seen as a progression from a Type A tympanogram to a Type C to a Type B tympanogram. By reflux or aspiration of unwanted secretions from the nasopharynx into the normally sterile middle-ear space, the fluid may then become infected — usually with bacteria. The virus that caused the initial URI (upper respiratory infection) can itself be identified as the pathogen causing the infection.