Overview
This lecture explains acute otitis media (AOM), focusing on its causes, anatomy, symptoms, diagnosis, treatment, and complications, especially in children.
Definition & Anatomy
- Acute otitis media is an infection and inflammation of the middle ear, common in children.
- The ear has three parts: outer, middle, and inner; the middle ear houses the ossicles (malleus, incus, stapes).
- Sound waves vibrate the tympanic membrane (eardrum), moving ossicles to transmit sound to the brain.
- The eustachian tube connects the middle ear to the nasopharynx, equalizing pressure and draining secretions.
Pathophysiology
- AOM is often triggered by viral upper respiratory infections causing eustachian tube swelling and dysfunction.
- Eustachian tube dysfunction leads to negative pressure, fluid buildup, and secondary infection.
- Main bacteria: Streptococcus pneumoniae, non-typeable Haemophilus influenzae, Moraxella catarrhalis.
- Children's eustachian tubes are shorter, more horizontal, and softer, increasing their risk.
Classification & Complications
- Suppurative otitis media: eardrum perforation with ear discharge (otorrhea).
- Chronic suppurative otitis media: persistent infection and ear discharge.
- Otitis media with effusion: residual middle ear fluid post-infection, often asymptomatic but risk for reinfection.
- Complications: mastoiditis, facial nerve palsy, intracranial abscesses, labyrinthitis.
Clinical Presentation & Diagnosis
- Symptoms: ear pain, fever, hearing loss, possible ear discharge, irritability, poor appetite.
- Otitis media with effusion mainly causes hearing loss; often follows acute infection.
- Diagnosis: otoscopic exam shows an inflamed, bulging eardrum with reduced mobility; discharge indicates suppurative otitis media.
Management
- Initial observation for 24–48 hours unless high risk or symptoms persist.
- Pain and fever managed with paracetamol or ibuprofen.
- If no improvement, antibiotics (usually amoxicillin) are started.
- Decongestants and antihistamines are not effective.
- Persistent effusion may require tympanostomy tubes, especially with hearing loss or developmental delay.
Key Terms & Definitions
- Acute otitis media (AOM) — Rapid-onset infection of the middle ear.
- Eustachian tube — Channel connecting middle ear and nasopharynx, involved in pressure equalization.
- Suppurative otitis media — Middle ear infection with eardrum rupture and pus discharge.
- Otitis media with effusion — Fluid in the middle ear without acute infection symptoms.
- Mastoiditis — Infection of the mastoid bone behind the ear.
Action Items / Next Steps
- Observe patients with AOM for 24–48 hours before prescribing antibiotics, unless high risk.
- Follow up on children after AOM to monitor for complications or persistent symptoms.
- Educate parents to return if symptoms worsen.