Acute otitis media

== Acute Otitis Media ==

Acute otitis media (AOM) is an infection of the middle ear, which is common in children but can also occur in adults. It is characterized by the rapid onset of signs and symptoms of inflammation in the middle ear.

Epidemiology

Acute otitis media is one of the most common infections in childhood, with the highest incidence occurring between 6 months and 2 years of age. It is estimated that by the age of 3, approximately 80% of children will have experienced at least one episode of AOM.

Etiology

The most common pathogens responsible for acute otitis media include:

• Streptococcus pneumoniae
• Haemophilus influenzae (non-typeable)
• Moraxella catarrhalis

Viral infections, such as those caused by respiratory syncytial virus (RSV) and influenza virus, can also predispose individuals to AOM by causing eustachian tube dysfunction.

Pathophysiology

Acute otitis media typically follows an upper respiratory tract infection. The infection leads to inflammation and swelling of the eustachian tube, which connects the middle ear to the nasopharynx. This results in impaired drainage and ventilation of the middle ear, creating a conducive environment for bacterial growth.

Clinical Presentation

Symptoms of acute otitis media include:

• Ear pain (otalgia)
• Fever
• Irritability in infants
• Hearing loss
• Otorrhea (discharge from the ear) if the tympanic membrane ruptures

On otoscopic examination, the tympanic membrane may appear bulging, erythematous, and immobile.

Diagnosis

Diagnosis of AOM is primarily clinical, based on the presence of:

• Acute onset of symptoms
• Middle ear effusion (fluid in the middle ear)
• Signs of middle ear inflammation (e.g., bulging of the tympanic membrane)

Pneumatic otoscopy and tympanometry can be used to assess the mobility of the tympanic membrane and confirm the presence of effusion.

Treatment

The management of acute otitis media includes:

• Pain management: Analgesics such as acetaminophen or ibuprofen are recommended for pain relief.
• Antibiotic therapy: Indicated in certain cases, such as severe symptoms, bilateral AOM in young children, or when symptoms persist. Amoxicillin is the first-line antibiotic.
• Observation: In select cases, especially in older children with mild symptoms, a period of observation may be appropriate before initiating antibiotics.

Complications

Potential complications of untreated or recurrent AOM include:

• Tympanic membrane perforation
• Chronic otitis media with effusion
• Mastoiditis
• Hearing loss
• Intracranial complications (rare)

Prevention

Preventive measures include:

• Vaccination against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib)
• Breastfeeding, which provides protective antibodies
• Avoidance of tobacco smoke exposure

Conclusion

Acute otitis media is a common and treatable condition, particularly in children. Prompt diagnosis and appropriate management are essential to prevent complications and ensure optimal outcomes.