Chronic otitis media

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Overview

Otitis media (OM) is a common illness in young children. OM has historically been associated with frequent and severe complications. Nowadays it is usually a mild condition that often resolves without treatment. For most children, progression to tympanic membrane perforation and chronic suppurative OM is unusual (low-risk populations); this has led to reevaluation of many interventions that were used routinely in the past. Evidence from a large number of randomized controlled trials can help when discussing treatment options with families. Indigenous children in the United States, Canada, Northern Europe, Australia, and New Zealand experience more OM than other children. In some places, Indigenous children continue to suffer from the most severe forms of the disease. Communities with more than 4% of the children affected by chronic tympanic membrane perforation have a major public health problem (high-risk populations). Higher rates of invasive pneumococcal disease, pneumonia, and chronic suppurative lung disease (including bronchiectasis) are also seen. These children will often benefit from effective treatment of persistent (or recurrent) bacterial infection.

Symptoms

The following are the most common symptoms of otitis media. However, each child may experience symptoms differently. Symptoms may include:


Unusual irritability


Difficulty sleeping or staying asleep


Tugging or pulling at one or both ears


Fever, especially in infants and younger children 


Fluid draining from ear(s)


Loss of balance


Hearing difficulties


Ear pain


The symptoms of otitis media may resemble other conditions or medical problems. Always consult your child's health care provider for a diagnosis.

Causes

Middle ear infections are usually a result of a malfunction of the eustachian tube, a canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the outer ear and the middle ear. When this tube is not working properly, it prevents normal drainage of fluid from the middle ear, causing a build up of fluid behind the eardrum. When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to acute otitis media. The following are some of the reasons that the eustachian tube may not work properly:


A cold or allergy which can lead to swelling and congestion of the lining of the nose, throat, and eustachian tube (this swelling prevents the normal drainage of fluids from the ear)


A malformation of the eustachian tube

Different types of otitis media include the following:


Acute otitis media. This middle ear infection occurs abruptly causing swelling and redness. Fluid and mucus become trapped inside the ear, causing the child to have a fever and ear pain.


Otitis media with effusion. Fluid (effusion) and mucus continue to accumulate in the middle ear after an initial infection subsides. The child may experience a feeling of fullness in the ear and it may affect his or her hearing or may have no symptoms.


Chronic otitis media with effusion. Fluid remains in the middle ear for a prolonged period or returns again and again, even though there is no infection. May result in difficulty fighting new infection and may affect the child's hearing.

Risk factors

Although acute otitis media can occur at any age, it is most commonly seen between the ages of 6 to 24 months. Approximately 80% of all children will experience a case of otitis media during their lifetime, and between 80% and 90% of all children will have otitis media with an effusion before school age.

Risk factors for ear infections include:

Age. ...

Group child care. ...

Infant feeding. ...

Seasonal factors. ...

Poor air quality. ...

Alaska Native heritage. ...

Cleft palate.

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Complications

The complications of otitis media were classified as extracranial and intracranial. Extracranial complications were mastoiditis, mastoid abscess, mastoid fistula, Bezold's abscess, Luc's abscess, zygomatic abscess, facial nerve paralysis, labyrinthitis and labyrinthine fistula.

Otitis media (OM) is the most common illness of childhood, and its management is a controversial topic. Serious complications of acute otitis media (AOM) include meningitis, brain abscesses, epidural abscesses, mastoiditis, permanent sensorineural hearing loss, and death.

Prevention

Prevention: Recurrent Otitis Media

Influenza Vaccine annually.

Pneumococcal Conjugate Vaccine (e.g. Prevnar 13) ...

Eliminate passive Tobacco smoke exposure.

Avoid bottle propping.

Avoid Pacifiers.

Consider diagnosis and management of comorbid chronic Allergic Rhinitis.

Xylitol gum. ...

Tympanostomy Tube indications.