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Otitis Media
Definition
- non specific term for an inflammation of the middle ear
Epidemiology
- most frequent diagnosis in infant and children
- acute episodes are more frequent during the first 3 years of life
Etiology
- season
o frequency is greater in winter months
- Malformation
o Anatomic problems
§ Cleft palate, adenoid hypertrophy, down’s syndrome
- Environmental factor
o History of recurrent acute Otitis media
o Respiratory tract infection
o Attending daycare center
o Parental smoking
- Race
o Predominant in Caucasians, native Americans
- Age at first episode
o Earlier experience of their first episode greater the risk of recurrent episode
Middle ear
- function
o regulation of atmospheric pressure between both side of tympanic membrane, protection from nasopharyngeal secretion, draining secretions from middle into the nasopharynx
Microbiology
- acute
o Streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis
- Less
o Staphylococcus aureus, streptococcus pyogenes, E.coli
Clinical presentation
- Otalgia, hearing loss, fever
- Nonspecific
- Irritability, lethargy, anorexia, or vomiting
Diagnose
- confirmed by exam of the tympanic membrane
o redness or opacity of tympanic membrane
o absence of light reflection
o bulging, indicative of effusion
Pharmacologic therapy
- antibiotic therapy
- Amoxicillin
o S.pneumoniae, H. influenzae
o Antibiotic of choice
- If no improvement within 24-48 hours, B-lactamase resistant antibiotics should be used
o TMP/SMX
o Cefixime, cefuroxime, Azetil, Cefaclor, Ceftibuten, Cefprozil, Cefpodoxime proxetil, Loracarbef, Azithromycin, Clarithromycin, Erythromycin-sulfisoxazole
- Tympanostomy
o Occurrence in young infants because of their inability of communicate symptoms
o Concurrence of an acute purulent conductive-sensorineural hearing loss
o Vertigo or tinnitus
o The presence of severe atelectasis
o Changes of the middle ear
o Presence of effusion for 2-3 month
Chemoprophylaxis
- Amoxicillin in one dose at bedtime or two doses every 12 hours
- Sulfisoxazole every 24 hours
- TMP/SMX every 24 hours
- Anti pneumococcal vaccine, Pnu-Imune and Pneumovax
o In child less two years of age, this vaccine has been responsible for an approximately 10-20% reduction
Side Effect
- GI
- Cutaneous
- Diarrhea is highest with ampicillin
- Rash, abdominal cramping
