Definition: presence of a middle ear infection

Acute Otitis Media: occurrence of bacterial infection within the

middle ear cavity.
Otitis Media with Effusion: presence of nonpurulent fluid within the
middle ear cavity
OM is the second most common clinical problem in childhood after
upper respiratory infection.

Classification of OM
Acute OM - rapid onset of signs & Symptoms, < 3 week
Subacute OM - 3 wks to 3 mos
Chronic OM - 3 mos or longer

 Microbiology
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Group A Streptococcus
Staph aureus
Pseudomonas aeruginosa

Virology
RSV - 74% of middle ear isolates
Rhinovirus
Parainfluenza virus
Influenza virus

Upper Respiratory Infections

Allergies
Craniofacial abnormalities (cleft palate)
Downs Syndrome
Passive smoking

Male gender
Sibling hx or recurrent otitis media
Early age of onset of AOM ( before 4 mo)
Bottle feeding, or breastfeeding for < 4 mo
Group day care
Exposure to tobacco smoke

 Epidemiology
Peak incidence in the first two years of life (6-12 months)
Boys more affected girls
50% of children 1 yr of age will have at least 1 episode.
1/3 of children will have 3 or more infections by age 3
90% of children will have at least one infection by age 6.

 PATHOGENESIS
Rout of infection
1. Ruptur of Timpanic membrane ...... Direct to middle ear
2. Eusthacius tube

 Symptom and sign

Neonates/Infants: change in behavior, irritability, tugging at ears,
decreased appetite, vomiting.
Children(2-4): otalgia, fever, noises in ears, cannot hear properly,
changes in personality
Children (>4): complain of ear pain, changes I personality

Clinical Stages
Stage I Stage of Salpingitis or Eustacius tube occlusion
- a feeling of blockage in the middle ear
- Otophoni and tinitus

- Tymphanic membrane retraction

Pneumatic Otoscopy: decreased tympanic
membrane mobility

Stage II Pre suppurative

Fever ( child )
Ear pain
Minimal hearing loss

Tympanic membrane
hiperhemis

Stage III Suppurative

Increase symptoms of stge II
Covultion and diarrhea (in children)

Tympanic membrane
hiperhemis and bulging

Pneumatic Otoscopy: decreased tympanic

membrane mobility

Stage IV. Stage of Complication

Mastoiditis is the major complication
Meningitis
Sinus lateral
Labyrinth
Cerebral
Tympanic membrane perforation
Otorhea

Stage IV. Resolution

Improve of symptoms
Discharge rapidly subsides
Resolve edema slowly
The small central perforation heal rapidly

 TREATMENT

Amoxicillin: 20-40 mg/kg/day tid for 10-14 days or,

Augmentin: 45 mg/kg/day po bid for 10-14 days
Cefzil
Pediazole ( erythromycin/sulfisoxazole)
Bactrim (trimethoprim/sulfamethoxazole
These medications are used as secondary agents if the primary
antibiotic has failed after 10 days and the symptoms persists.

 INDICATIONS FOR TYMPANOCENTESIS

1.
2.
3.
4.
5.

Toxic appearing child

Failed treatment regimen with antibiotics
Suppurative complications
Immunosuppressed pt.
Newborn infant in which the usual pathogens
may not be the case.

 COMPLICATIONS
1.
2.
3.
4.
5.
6.
7.
8.

Hearing loss: conductive, sensoneural, mixed)

Acute mastoiditis: before the advent of antibiotics
Chronic perforation of the TM
Tympanosclerosis
Cholesteatoma
Chronic suppurative OM
Cholesterol granuloma: Blue drum syndrome
Facial nerve paralysis

 Intracranial complications
1.
2.
3.
4.
5.
6.

Bacterial meningitis
Epidural abscess
Subdural empyema
Brain abscess
Otitic hydrocephalus
Lateral sinus thrombosis