Otitis Media Cause
- Otitis media is an inflammation of the middle ear. Acute otitis media involves the rapid onset of signs and symptoms of inflammation in the middle ear that manifests clinically as one or more of the following: otalgia (denoted by pulling of the ear in some infants), hearing loss, fever, or irritability. Otitis media with effusion (accumulation of liquid in the middle ear cavity) differs from acute otitis media in that signs and symptoms of an acute infection are absent.
- Otitis media is the most frequent diagnosis in infants and children.
- Risk factors contributing to increased incidence of otitis media include the winter season, attendance at a day care center, non-breast feeding in infants, native American or Inuit origin, early age at first infection, and nasopharyngeal colonization with middle ear pathogens.
- Eustachian tube anatomy is different in children compared with adults and may cause improper drainage of the middle ear.
- Abnormal function of the eustachian tube can cause reflux transudation of liquid in the middle ear and proliferation of bacteria, resulting in acute otitis media.
- Streptococcus pneumoniae is the most common cause of acute otitis media (20% to 35%). Nontypable strains of Haemophilus influenzae and Moxarella catarrhalis are each responsible for 20% to 30% and 20% of cases, respectively. In 44% of cases, a viral etiology is found with or without concomitant bacteria.
- S. pneumoniae isolates are often intermediate resistant to penicillin (8% to 34%) and some are highly penicillin resistant (12% to 21%). Penicillin-resistant isolates are often resistant to multiple antibiotics. Î²-Lactam resistance occurs in about 23% to 35% of H. influenzae and in up to 100% of M. catarrhalis.
Acute otitis media presents as an acute onset of signs and symptoms of middle ear infection such as otalgia, irritability, and tugging on the ear, following cold symptoims of runny nose, nasal congestion, or cough.
Resolution of acute otitis media occurs over 1 week. Pain and fever tend to resolve over 2 to 3 days.
The goals of treatment include reduction in signs and symptoms, eradication of infection, and prevention of complications. Avoidance of unnecessary antibiotic use is another goal in view of S. pneumonia.
- Antimicrobial therapy is used to treat otitis media; however, a high percentage of children will be cured with symptomatic treatment alone.
- Acetaminophen or a nonsteroidal anti-inflammatory agent, such as ibuprofen, can be used to relieve pain and malaise in acute otitis media. Decongestants, antihistamines, topical corticosteroids, or expectorants have not been proven effective for acute otitis media.
- Surgical insertion of tympanostomy tubes (T tubes) is an effective method for the prevention of recurrent otitis media.
- Amoxicillin is the drug of choice for acute otitis media (40 to 45 mg/kg/day). High-dose amoxicillin (80 to 90mg/kg/day) is recommended if drug-resistant S. pneumoniae is suspected or a patient is at high risk for a resistant infection. Treatment recommendations for acute otitis media.
- If treatment failure occurs with amoxicillin, an agent should be chosen with activity against Î²-lactamase-producing H. influenzae and M. catarrhalis as well as drug-resistant S. pneumoniae (such as amoxicillin-clavulanate, cefuroxime, or intramuscular ceftriaxone).
- Patients with penicillin allergy can be treated with a cephalosporin (some clinicians feel that the incidence of cross-reaction is sufficiently low in patients who have not experienced immediate pencillin-hypersensitivity reactions) or a macrolide such as azithromycin, or clarithromycin, erythromycin/ sulfisoxazole, trimethoprim/sulfamethoxazole, or, if S. pneumoniae is documented, clindamycin.
- It is difficult to identify who will benefit from antimicrobial therapy. With or without treatment, about 60% of children who have acute otitis media are symptom-free within 24 hours. In almost 40% of the remaining children, antibiotic use reduces the duration of symptoms by about 1 day.
- A meta-analysis reported no difference in cure rates with short (less than 7 days) and usual durations (at least 7 days) of antibiotic therapy in children. Five days of therapy is effective in acute uncomplicated otitis media.
- Antibiotic Prophylaxis of Recurrent Infections
- Recurrent otitis media is defined as at least 3 episodes in 6 months or at least 4 episodes in 12 months. Recurrent infections are of concern because patients under 3 years of age are at high risk for hearing loss and language and learning disabilities. Data from studies generally do not favor prophylaxis. A meta-analysis demonstrated that prophylaxis against these infections leads to one infection prevented each time one child is treated for 9 months.
- Vaccination against influenza and pneumococcus may decrease risk of acute otitis media, especially in those with recurrent episodes. Immunization with the influenza vaccine reduces the incidence of acute otitis media by 36%.
- Treatment failure is a lack of clinical improvement after 3 days in the signs and symptoms of infection including pain, fever and redness or bulging of the tympanic membrane.
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