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25145596 Otitis Media

25145596 Otitis Media

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Published by: Russel Ann Go on May 31, 2010
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Otitis media
(Latinfor "Middleotitis") isinflammationof themiddle ear,or middle ear  infection.Otitis media occurs in the area between the ear drum (the end of theouter ear ) and theinner  ear , including a duct known as theeustachian tube.It is one of the two categories of ear  inflammation that can underlie what is commonly called an earache, the other beingotitisexterna.Diseases other than ear infections can also cause ear pain, including cancers of anystructure that shares nerve supply with the ear andshingleswhich can lead toherpes zoster  oticus.
Otitis media has many degrees of severity, and various names are used to describe each. Theterminology is sometimes confusing because of multiple terms being used to describe thesame condition. A common misconception with ear infection is that sufferers think that asymptom is itchy ear. Although sufferers may feel discomfort, an itchy ear is not a symptomof ear infection.
Acute otitis media
Acute otitis media (AOM) is most often purely viral and self-limited, as is its usualaccompanying viral URI (upper respiratory infection). There is congestion of the ears and perhaps mild discomfort and popping, but the symptoms resolve with the underlying URI. If the middle ear, which is normally sterile, becomes contaminated with bacteria, pus and pressure in the middle ear can result, and this is called acute bacterial otitis media. Viral acuteotitis media can lead to bacterial otitis media in a very short time, especially in children, but itusually does not. The individual with bacterial acute otitis media has the classic "earache", pain that is more severe and continuous and is often accompanied by fever of 102 °F (39 °C)or more.[citation needed]. Bacterial cases may result in perforation of the ear drum, infectionof the mastoid space (mastoiditis) and in very rare cases further spread to cause meningitis.
1st phase
- exudative inflammation lasting 1-2 days, fever, rigors, meningism(occasionally in children), severe pain (worse at night), muffled noise in ear, deafness,sensitivemastoidprocess.
2nd phase
- resistance and demarcation lasting 3-8 days. Pus and middle ear exudatedischarge spontaneously and afterwards pain and fever begin to decrease. This phase can beshortened with topical therapy.
3rd phase
- healing phase lasting 2-4 weeks. Aural discharge dries up and hearing becomesnormal.
Otitis media with effusion
Otitis media with effusion (OME), also called
secretory otitis media
(SOM), issimply a collection of fluid that occurs within the middle ear space as a result of the negative pressure produced by altered Eustachian tube function. This can occur purely from a viralURI, with no pain or bacterial infection, or it can precede and/or follow acute bacterial otitismedia. Fluid in the middle ear sometimes causes conductive hearing impairment, but only
when it interferes with the normal vibration of the eardrum by sound waves. Over weeks andmonths, middle ear fluid can become very thick and glue-like (thus the name
glue ear
),which increases the likelihood of its causing conductive hearing impairment. Early-onsetOME is associated with feeding while lying down and early entry into groupchild care, while parentalsmoking, too short a period of  breastfeedingand greater amounts of time spent in group child care increased the duration of OME in the first two years of life.
Chronic suppurative otitis media
Chronic suppurative otitis media involves a perforation (hole) in the tympanic membrane andactive bacterial infection within the middle ear space for several weeks or more. There may be enough pus that it drains to the outside of the ear (otorrhea), or the purulence may beminimal enough to only be seen on examination using a binocular microscope. This disease ismuch more common in persons with poor Eustachian tube function. Hearing impairmentoften accompanies this disease.
Signs and symptoms
When themiddle ear becomes acutely infected by bacteria,pressurebuilds up behind theear  drum, usually but not always causing pain. In severe or untreated cases, thetympanicmembranemay rupture, allowing the pusin the middle ear space to drain into theear canal.If  there is enough of it, this drainage may be obvious. Even though the rupture of the tympanicmembrane suggests a traumatic process, it is almost always associated with the dramaticrelief of pressure and pain. In a simple case of acute otitis media in an otherwise healthy person, the body's defenses are likely to resolve theinfectionand the ear drum nearly alwaysheals.Antibioticadministration can prevent perforation of the eardrum and hasten recoveryof the ear.Instead of the infection and eardrum perforation resolving, however, drainage from themiddle ear can become a chronic condition. As long as there is active middle ear infection,the eardrum will not heal. TheWorld Health OrganizationdefinesChronicSuppurativeOtitis Media (CSOM) as "a stage of ear disease in which there is chronic infection of the middle ear cleft, a non-intact tympanic membrane (i.e. perforated eardrum) and discharge (otorrhoea),for at least the preceding two weeks" (WHO 1998). (Notice WHO's use of the term
todenote a bacterial process, whereas the same term is generally used by ear  physiciansin theUnited States to denote simple fluid collection within the middle ear behind an intacteardrum.
Chronic otitis media
is the term used by most ear physicians worldwide to describea chronically infected middle ear with eardrum perforation.)
and nontypable
 Haemophilus influenzae
are the most common bacterial causes of otitis media. Tubal dysfunction leads to the ineffective clearing of bacteriafrom the middle ear. In older adolescents and young adults, the most common cause of ear infections during their childhoods was
. The role of the anti-
vaccine that children are regularly given in changing patterns of ear infections isunclear, as this vaccine is active only against strains of serotype b, which rarely cause otitismedia.
As well as being caused by
it canalso be caused by the common cold. Colds indirectly cause many cases of otitis media bydamaging the normal defenses of the epithelial cells in the upper respiratory tract.Another common culprit of otitis media includes
,agram-negative,  aerobic, oxidase positivediplococcus. Less commonly otitis media can be caused by
.If none of the above bacteria is found to be in the serum, the next possible organismresponsible is the Respiratory Syncytial Virus (RSV).
Typically, acute otitis media follows acold: after a few days of astuffy nosethe ear becomes involved and can cause severe pain. The pain will usually settle within a day or two, but canlast over a week. Sometimes theear drumruptures, discharging pusfrom the ear, but the ruptured drum will usually heal rapidly.At an anatomic level, the typical progression of acute otitis media occurs as follows: thetissues surrounding theEustachian tubeswell due to anupper respiratory infection,allergies,  or dysfunction of the tubes. TheEustachian tuberemains blocked most of the time. The air  present in themiddle ear is slowly absorbed into the surrounding tissues. A strong negative pressure creates a vacuum in the middle ear, and eventually the vacuum reaches a pointwhere fluid from the surrounding tissues accumulates in the middle ear. This is seen as a progression from a Type Atympanogramto a Type C to a Type B tympanogram. The fluidmay become infected. It has been found that dormant bacteriabehind thetympanic membrane  (eardrum) multiply when the conditions are ideal, infecting the middle ear fluid.
Susceptibility in children
Children below the age of seven years are much more prone to otitis media since theEustachian tube is shorter and at more of a horizontal angle than in the adult ear. They alsohave not developed the same resistance to viruses and bacteria as adults. Numerous studieshave correlated the incidence of acute otitis media in children with various factors such asnursing in infancy, bottle feeding when supine, parental smoking, diet, allergies, andautomobile emissions; but the most obvious weakness of such studies is the inability tocontrol the variable of exposure to viral agents during the studies. One must also keep inmind thatcorrelation does not establish causation. Breastfeeding for the first twelve monthsof life is associated with a reduction in the number, and duration of all OM infections.Well pacifier use is associated with more frequent episodes of AOM.

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