Acute Otitis Media

Epidemiology

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Etiology

  • Eustachian Tube Dysfunction (see Eustachian Tube Dysfunction, [[Eustachian Tube Dysfunction]]): most important etiologic factor which contributes to the development of acute otitis media
    • Although descent of the soft palate muscle sling relative to the eustachian tube orifice during adolescence improves eustachian tube patency (and decreases the incidence of acute otitis media with age), poor tubal function may persist into adulthood
    • Persistent eustachian tube dysfunction results in a relative negative pressure in the middle ear space: consequently, lack of aeration and accumulation of middle ear effusion increase the risk of acute otitis media and otitis media with effusion
    • Etiology of Eustachian Tube Dysfunction
      • Extrinsic Eustachian Tube Compression: due to nasopharyngeal tumor or enlarged adenoid
      • Mucosal Disease: due to inflammatory etiology, immunologic impairment, or immotile cilia
      • Seasonal Allergic Rhinitis
      • Upper Respiratory Tract Infection

Microbiology

Common Microbiologic Etiologies

  • Haemophilus Influenzae (see Haemophilus Influenzae, [[Haemophilus Influenzae]]): common etiology
    • Associated with non-typable strains
  • Streptococcus Pneumoniae (see Streptococcus Pneumoniae, [[Streptococcus Pneumoniae]]): most important bacterial etiology in adult acute otitis media

Less Common Microbiologic Etiologies

  • Aspergillus (see Aspergillus, [[Aspergillus]]): recovered mainly from middle ear fluid in patients with chronic suppurative otitis media
  • Candida (see Candida, [[Candida]]): recovered mainly from middle ear fluid in patients with chronic suppurative otitis media
  • Chlamydia Trachomatis (see Chlamydia Trachomatis, [[Chlamydia Trachomatis]])
  • Diphtheria (see Diphtheria, [[Diphtheria]])
  • Influenza Virus (see Influenza Virus, [[Influenza Virus]])
  • Moraxella Catarrhalis (see Moraxella Catarrhalis, [[Moraxella Catarrhalis]])
  • Mycoplasma Pneumoniae (see Mycoplasma Pneumoniae, [[Mycoplasma Pneumoniae]]): unclear if this organism is etiologic of acute otitis media
    • Although experimental infection of adults has been demonstrated to cause hemorrhagic bullous myringitis, Mycoplasma Pneumoniae is rarely recovered from patients with acute otitis media in most studies
    • Some patients with Mycoplasma Pneumoniae pneumonia have concurrent acute otitis media
  • Respiratory Syncytial Virus (RSV) (see Respiratory Syncytial Virus, [[Respiratory Syncytial Virus]])
  • Rhinovirus (see Rhinovirus, [[Rhinovirus]])
  • Staphylococcus Aureus (see Staphylococcus Aureus, [[Staphylococcus Aureus]]):
  • Streptococcus Pyogenes (Group A Beta-Hemolytic Streptococcus) (see xxxx, [[xxxx]]): less common etiology currently (although was the most common etiology in the pre-antibiotic era)
  • Tetanus (see Tetanus, [[Tetanus]])
  • Tuberculosis (see Tuberculosis, [[Tuberculosis]])

Diagnosis

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Clinical Manifestations

Otolaryngologic Manifestations

  • Bullous Myringitis
  • Otalgia
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Other Manifestations

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Treatment

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References

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