Acute otitis Media

Question 1

Definition of Acute otitis media (AOM)

Answer 1

An infection involving the middle ear
space and is a common complication of viral respiratory illnesses.
• It is marked by inflammation of the mucosa lining the middle ear
space and the presence of fluid in the middle ear and

Question 2

Age

Answer 2

Otitis media occurs at all age group, but the peak age group is
children in the FIRST THREE YEARS OF LIFE

Question 3

Statistics

Answer 3

• More than 80% of children experience at least one episode of AOM before the age of 2 years.
• Children with anatomic anomalies (e.g., cleft palate, cleft uvula) or immunologic deficiencies encounter more AOM than their
peers.
• Environmental risk factors include childcare attendance,
exposure to older siblings, exposure to tobacco smoke, absence
of breastfeeding, bottle feeding in a supine position, and pacifier
use.

Question 4

Aetiology

Answer 4

1. Respiratory viruses account for most cases of AOM and are self-
   limited.
2. Coinfections of the middle ear with a virus and a bacterium
   demonstrate the role that both play in the development of acute,
   suppurative otitis media or pus drum.
3. The most common bacteria responsible for AOM are
   Streptococcus pneumoniae,
   nontypable Haemophilus
   influenzae,
   and Moraxella catarrhalis.
   Unfortunately, an etiologic diagnosis in an office setting is not readily feasible.

Question 5

Diagnosis

Answer 5

1. Diagnosis is generally made with conventional otoscopy which
   shows fluid in the middle ear and bulging or decreased mobility and inflammation of the tympanic membrane
2. Tympanocentesis and bacterial culture of aspirated middle ear
   fluid are the means for making an etiologic diagnosis. However, tympanocentesis is not recommended unless the patient is toxic or is not responding to empirical therapy.

Question 6

Management

Answer 6

➢ Management of otitis media
1. Antimicrobial agents to cover common bacterial pathogens:
• Amoxicillin, Amoxicillin-clavulanic acid, Cephalosporin
2. Symptomatic treatment:
• Analgesics to control the pain : acetaminophen, ibuprofen
• Decongestants and antihistamines to reduce congestion of the respiratory mucosa and relieve obstruction of the Eustachian tube
3. Tympanocentesis : placement of tympanostomy tubes for children with severe
pain and unresponsive to antibiotics.
• provide an etiologic diagnosis
• relieve pressure in the middle ear space and provide relief of otalgia.

Question 7

Prevention

Answer 7

The following actions may help prevent ear infections:
• breastfeeding during infancy,
• avoiding exposure to tobacco smoke,
• feeding the child with the head elevated and avoiding pacifiers
when possible, and avoiding settings that increase a child’s
exposure to cold viruses.
• The pneumococcal conjugate vaccine may have a modest effect
on the incidence of AOM,
• Treatment of influenza infections with oseltamivir may prevent
middle ear involvement and thus decrease the occurrence of
AOM during influenza season