Otitis Media

Abstract

Otitis media represents a broad spectrum of disease, which include acute otitis media and otitis media with effusion. As immunization with the pneumococcal conjugate vaccine has become more widespread, the microbiological landscape of otitis media has changed, which affects the treatment options facing clinicians worldwide. This review discusses the diagnosis and medical management of acute and chronic suppurative otitis media, the changes noted over the past decade, and briefly expounds on the surgical management of their severe complications.

Acute Otitis Media- An Update

“…The importance of other environmental factors cannot be underestimated in the pathogenesis of AOM; Paternal smoking is one of OM risk factors [1,3,8,10,14]; it causes mucosal inflammation, goblet hyperplasia and an increase in the production of mucus, by this it impairs mucosal immunity and increases bacterial colonization by enhancing bacterial binding to respiratory epithelium [1,10]. Children of mothers who smoked during pregnancy and stopped after delivery still have higher incidence of AOM [10].…”

“…Children of mothers who smoked during pregnancy and stopped after delivery still have higher incidence of AOM [10]. Children with bottle feeding is another well known risk factor [1,3,8,10]; it is believed that passive immunity through the breast milk gives some protection [1], bottle-fed infants have higher nontypeable Haemophilus influenzae prevalence and lower immunoglobulin G antibodies [8]. Some studies found a role of Gastro esophageal reflux (GERD) disease [1,18]; GERD is found in 62.9% of patient with rOM.…”

“…Certain vitamin and dietary deficiencies can be found in cases of AOM and rOM; like vitamin A, zinc, EPA (an omega 3 fatty acid) and selenium deficiencies [13]. There are other risks factors that are related to AOM, like younger age [1,14], attendance to day care centers [3,8,10], prematurity [8], increased number of siblings, dummy use [1,8], Autumn and winter seasons [1], craniofacial anomaly [14], asthma [3] and atop [3,14] (Table 1). …”

“…Otitis media (OM) has a wide spectrum of diseases that include acute otitis media (AOM), recurrent otitis media (rOM), otitis media with effusion (OME), chronic otitis media with effusion and chronic otitis media [1,2,3]; AOM can be defined as a rapid onset of fever and otalgia [1,2,4], if the child has ≥3 episodes of AOM in the preceding 6 months, or ≥4 episodes in the preceding 12 months then he is considered to have recurrent OM [1,5,6], presence of fluid in the middle ear with absence of signs and symptoms is defined as otitis media with effusion (OME), and if the fluid persisted more than 3 months then it is considered as chronic otitis media with effusion [1], chronic suppurative otitis is defined as discharge with tympanic membrane (TM) perforation for more than 3 months [1]. Patients who have more than 6 episodes in the first 6 years of life are said to be otitis prone [7].…”

Endoscopic examination of the nasal cavity and nasopharynx in patients with otitis media

“…[1,2] Nasal and nasopharyngeal pathologies have long been recognized as important factors in the pathogenesis of otitis media. It has been traditionally hypothesized that a mass in the nasopharynx causes an obstacle to airf low through the Eustachian tube (ET), thereby a negative pressure in the middle ear followed by an effusion.…”