Acute Otitis Media:

A Summary

What is AOM?

Acute otitis media: Inflammation of the middle ear in which there is fluid in the middle ear accompanied by signs or symptoms of ear infection: a bulging eardrum usually accompanied by pain; or a perforated eardrum, often with drainage of purulent material (pus). Acute otitis media is the most frequent diagnosis in sick children in the U.S., especially affecting infants and preschoolers. Almost all children have one or more bouts of otitis media before age 6.

http://www.medicinenet.com/script/main/art.asp?articlekey=26131

Risk Factors Risks factors can be any of the following: (Medline Plus)

Attending day care (especially those with more than 6 children) Changes in altitude or climate Cold climate Exposure to smoke Family history of ear infections Not being breastfed Pacifier use Recent ear infection Recent illness of any type Drinking from Sippy cups Drinking a bottle while lying down   Medline Plus (2014) “Ear infection – acute”, Updated by: Neil K. Kaneshiro, MD,

MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. https://www.nlm.nih.gov/medlineplus/ency/article/000638.htm

Pathogenesis

The pathogenesis of OM is multifactorial, involving the adaptive and native immune system, Eustachian-tube dysfunction, viral and bacterial load, and genetic and environmental factors.

Rovers, MM., Schilder, AGM., Zielhuis, GA., Rosenfeld, RM., “Otitis media”, THE LANCET Vol 363 • February 7, 2004 • www.thelancet.com

Pathophysiology

“The pathophysiology of acute otitis media is complex and multifactorial. It is characterized by inflammation of the middle ear with an infiltration of leukocytes, macrophages and mast cells. The resulting effusion contains a large amount of inflammatory mediators, among which are cytokines.”

Barzilai, A., Dekel, B., Dagan, R., Leibovitz, “Middle ear effusion IL-6 concentration in bacterial and non-bacterial acute otitis media”, Acta Psediatr 89: 1068-71. Taylor & Francis. ISSN 0803-5253

Diagnosis Despite numerous investigations precise diagnosticcriteria

and optimal treatment for acute otitis media remain uncertain and controversial.

History of prior infections, symptoms and physical findings are all used. Perforation of the tympanic membrane was also seen as a criteria. Tympanometry is often not valid because of the difficulty in gaining cooperation from the child.

“The fact that doctors were very certain of their diagnosis in only 58% of children aged 0-12 months is disconcerting.”

Diagnosis is difficult and not always reliable, thus the controversy surrounding the use of antibiotics for this illness.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1662354/pdf/bmj00168-0036.pdf

Treatment Pain should be controlled Antibiotics should be prescribed for AOM in children 6 month or older

with severe symptoms of at least 48 hours duration or temperature of 102 F or higher

Antibiotics should be prescribed for children 6 months to 23 months without severe symptoms

For children without severe symptoms or non severe AOM observation should be provided with close follow-up to monitor need for antibiotics.

Prophylactic antibiotics should not be prescribed to reduce the frequency of episodes of AOM in children with recurrent AOM. Tympanostomy tubes may be offered for recurrent AOM (3 episodes in 6 months or 4 episodes in 1 year with 1 episode in the preceding 6 months).

http://www.aafp.org/patient-care/clinical-recommendations/all/otitis-media.html

Summary Acute Otitis Media is the scourge of parents and young children

around the world. Infants as young as 1 month can develop the painful infection of the middle ear. Their short Eustachian tubes block drainage from the middle ear and this fluid can become infected. Most episodes will clear on their own but some persist and will need antibiotics. Some prevention ideas include a diet of fresh foods, avoidance of sugary drinks and processed foods. If the young children are bottle fed, it should be done in an upright position. Treatment varies and is individualized based on age, severity of symptoms and child’s history of infections. AOM is a common child hood illness and it can be treated and held to a minimum with proper care and supervision. Without care and supervision it can develop into a chronic, reoccurring illness that can damage the middle ear causing hearing loss and painful attacks. AOM, although not itself serious is not to be ignored but managed with care.