It is a bacterial or Infection in the middle ear’ usually secondary to a upper respiratory tract infection (URTI).Although acute otitis media can occur at any age’ it is most common in young children’ particularly from age 3 mo to 3 yr. Microorganisms may migrate from the nasopharynx to the middle ear by moving over the surface of the Eustachian tube’s mucous membrane or by propagating in the lamina propria of the mucous membrane as a spreading cellulitis or thrombophlebitis.
- Gran-negative enteric bacilli’Escherichia coli’ Staphylococcus aureus.
After the neonatal period
- E. coli rarely causes acute otitis media
- In older infants and children 14 yr. Streptococcus pneumoniae’Haemophilus influezae’grap A β-hemolytic streptpococci’Moraxella(Branhamella) catarrhalis’ and S. aureus .
- Viral otitis media is usually complicated by secondary invasion by one of these bacteria.
In those<yr ‘S pneumonia; group
- Β-hemolytic streptococci’ S aureus’H. inflenzae.
- Day care
- Formula feeding
- Passive smoking
- Family history of middle ear disease
- Acute otitis media in first year of life is a risk factor for recurrent acute otitis media
SIGNS AND SYMPTOMS
- Severe earache
- Hearing loss
- Fever (up to 40.50° C[105.0°F])
- Nausea and vomiting
- Bulged erythematous tympanic membrane
- Purulent otorrhea
- Referred pain from the jaw or teeth
- Acoustic reflectometry
- Hearing testing
- Nasopharyngeal cultures
- To relieve symptoms
- Hasten resolution of the infection
- Reduce the chance of labyrinthine and intracraninal infectious
- Reduce the complications and residual damage to the hearing mechanism in the middle ear.
- 1st line agents:moxicillin’ co-trimoxazole’erythromycin
- 2nd line agents: Amoxicillin/clavulanate’cefdinir’ cefpodoxime’cefuroxime axetil’clarithromycin.
- 3rd line agents: Ceftiaxone’clindamycin’levofloxacin.
Myringotomy should be considered if the trmpanic membrane is bulged or if pain’ fever’ vomiting’and diarrhea are severe or persistent.
o Acute mastoiditis
o Hearing loss
o Fcial paralysis
o Conductive and sensorineural hearing loss
o Epidural abscess
o Atrophy and scarring of eardrum’ chronic perforation and otorrhea
o Meningitis’ brain abscess’ lateral sinus thrombosis’ subdural empyema’ and otitic hydrocepPROGNOSIS
Symptoms of otitis media usually improve in 48-72hrs’otitis media with effusion following acute otitis resolved in 90%by 3 months. Otitis media with effusion have lesser percentage of complications.