Otitis media Classification and external resources
ICD-10	H65.-H67.
ICD-9	381-382
DiseasesDB	29620 serous, 9406 suppurative
MedlinePlus	000638 acute, 007010 with effusion, 000619 chronic
eMedicine	emerg/351  ent/426 complications, ent/209 with effusion, ent/212 Medical treat. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors , ent/211 Surgical treat. ped/1689

Otitis media is inflammation of the middle ear, or middle ear infection (the word otitis is Latin and it means “inflammation of the ear”, and media means middle). Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens The middle ear is the portion of the ear internal to the Eardrum, and external to the Oval window of the Cochlea.

Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the Eustachian tube. The Eustachian tube (or auditory tube) is a tube that links the Pharynx to the Middle ear. It is one of the two categories of ear inflammation that can underly what is commonly called an earache, the other being otitis externa. Otitis externa ("swimmer's ear" is an Inflammation of the outer Ear and ear canal Diseases other than ear infections can also cause ear pain, including cancers of any structure that shares nerve supply with the ear.

Otitis media is very common in childhood, with the average toddler having two to three episodes a year, almost always accompanied by a viral upper respiratory infection (URI), mostly the common cold. Upper respiratory tract infections, ( URTI or URI) are the illnesses caused by an acute Infection which involves the upper Respiratory tract: Acute viral nasopharyngitis or acute coryza, usually known as the common cold, is a highly contagious viral Infectious disease of the The rhinoviruses (nose viruses) that cause the common cold infect the Eustachian tube that goes from the back of the nose to the middle ear, causing swelling and compromise of pressure equalization, which is the normal function of the tube. Rhinovirus (from the Greek rhin - which means "nose" is a genus of the Picornaviridae family of Viruses Rhinoviruses The Eustachian tube (or auditory tube) is a tube that links the Pharynx to the Middle ear. In general, the more severe and prolonged the compromise of Eustachian tube function, the more severe the consequences are to the middle ear and its delicate structures. If a person is born with poor Eustachian tube function, this greatly increases the likelihood of more frequent and severe episodes of otitis media. Progression to chronic otitis media is much more common in this group of people, who often have a family history of middle ear disease.

Contents 1 Types 1.1 Acute otitis media 1.2 Otitis media with effusion 1.3 Chronic suppurative otitis media 2 Progression 3 Otorrhea: infected drainage from the middle ear 4 Causes 5 Susceptibility in children 6 Treatment 6.1 Acute otitis media 6.2 Chronic cases or with effusion 6.3 Alternative therapies 7 Gallery 8 References

Types

Otitis media has many degrees of severity, and various names are used to describe each. The terminology is sometimes confusing because of multiple terms being used to describe the same condition. A common misconception with ear infection is that sufferers think that a symptom is itchy ear. Although sufferers may feel discomfort, an itchy ear is not a symptom of ear infection.

Acute otitis media

Acute otitis media (AOM) is most often purely viral and self-limited, as is its usual accompanying viral URI. 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 acute otitis media can lead to bacterial otitis media in a very short time, especially in children, but it usually 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. . Bacterial cases may result in perforation of the ear drum, infection of the mastoid space (mastoiditis) and in very rare cases further spread to cause meningitis. Mastoiditis is an infection of the Mastoid process, the portion of the Temporal bone of the Skull that is behind the Ear. Meningitis is Inflammation of the protective membranes covering the Brain and Spinal cord, known collectively as the Meninges.

Otitis media with effusion

Otitis media with effusion (OME), also called serous or secretory otitis media (SOM), is simply 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 viral URI, with no pain or bacterial infection, or it can precede and/or follow acute bacterial otitis media. 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 and months, 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-onset OME is associated with feeding while lying down and early entry into group child care, while parental smoking, a short period of breastfeeding and greater amounts of time spent in group child care increased the duration of OME in the first two years of life. Childcare (also written child care and babycare is the act of caring for and supervising minor Children (In Australia Daycare is referred Smoking is a practice where a substance most commonly Tobacco, is burned and the Smoke tasted or inhaled Breastfeeding is the feeding of an Infant or young Child with Breast milk directly from human Breasts, not from a Baby bottle or other ^[1]

Chronic suppurative otitis media

Chronic suppurative otitis media involves a perforation (hole) in the eardrum and active 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 be minimal enough to only be seen on examination using a binocular microscope. This disease is much more common in persons with poor Eustachian tube function. Hearing impairment often accompanies this disease.

Progression

Typically, acute otitis media follows a cold: after a few days of a stuffy nose the ear becomes involved and can cause severe pain. The pain will usually settle within a day or two, but can last over a week. Sometimes the ear drum ruptures, discharging pus from the ear, but the ruptured drum will usually heal rapidly.

At an anatomic level, the typical progression of acute otitis media occurs as follows: the tissues surrounding the Eustachian tube swell due to an upper respiratory infection, allergies, or dysfunction of the tubes. The Eustachian tube (or auditory tube) is a tube that links the Pharynx to the Middle ear. The Eustachian tube remains blocked most of the time. The air present in the middle 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 point where fluid from the surrounding tissues accumulates in the middle ear. This is seen as a progression from a Type A tympanogram to a Type C to a Type B tympanogram. Tympanometry is an examination used to test the condition of the Middle ear and mobility of the Eardrum ( Tympanic membrane) and the conduction bones by The fluid may become infected. It has been found that dormant bacteria behind the Tympanum (eardrum) multiply when the conditions are ideal, infecting the middle ear fluid.

Otorrhea: infected drainage from the middle ear

When the middle ear becomes acutely infected by bacteria, pressure builds up behind the ear drum, usually but not always causing pain. In severe or untreated cases, the tympanic membrane may rupture, allowing the pus in the middle ear space to drain into the ear canal. If there is enough of it, this drainage may be obvious. Even though the rupture of the tympanic membrane suggests a traumatic process, it is almost always associated with the dramatic relief 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 the infection and the ear drum nearly always heals. Antibiotic administration can prevent perforation of the eardrum and hasten recovery of the ear.

Instead of the infection and eardrum perforation resolving, however, drainage from the middle ear can become a chronic condition. As long as there is active middle ear infection, the eardrum will not heal. The World Health Organization defines Chronic Suppurative Otitis 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 serous to denote a bacterial process, whereas the same term is generally used by ear physicians in the United States to denote simple fluid collection within the middle ear behind an intact eardrum. Chronic otitis media is the term used by most ear physicians worldwide to describe a chronically infected middle ear with eardrum perforation. )

Causes

Streptococcus pneumoniae and nontypable Haemophilus influenzae are the most common bacterial causes of otitis media. Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus aerotolerant anaerobe and a member of the Genus Tubal dysfunction leads to the ineffective clearing of bacteria from the middle ear. In older adolescents and young adults, the most common cause of ear infections during their childhoods was Haemophilus influenzae. Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, is a non-motile Gram-negative Coccobacillus The role of the anti-H. influenzae vaccine that children are regularly given in changing patterns of ear infections is unclear, as this vaccine is active only against strains of serotype b, which rarely cause otitis media.

As well as being caused by Streptococcus pneumoniae and Haemophilus influenzae it can also be caused by the common cold. Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus aerotolerant anaerobe and a member of the Genus Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, is a non-motile Gram-negative Coccobacillus Colds indirectly cause many cases of otitis media by damaging the normal defenses of the epithelial cells in the upper respiratory tract.

Another common culprit of otitis media includes Moraxella catarrhalis, a gram-negative, aerobic, oxidase positive diplococcus. Moraxella catarrhalis is a Gram-negative, Aerobic, oxidase-positive Diplococcus which may both colonize and cause Respiratory Gram-negative bacteria are those Bacteria that do not retain Crystal violet dye in the Gram staining protocol A diplococcus (plural diplococci) is a round bacterium (a Coccus) that typically occurs in pairs of two joined cells Less commonly otitis media can be caused by Mycobacterium tuberculosis.

Susceptibility in children

Children below the age of seven years are much more prone to otitis media since the Eustachian tube is shorter and at more of a horizontal angle than in the adult ear. They also have not developed the same resistance to viruses and bacteria as adults. Numerous studies have correlated the incidence of acute otitis media in children with various factors such as nursing in infancy, bottle feeding when supine, parental smoking, diet, allergies and automobile emissions; but the most obvious weakness of such studies is the inability to control the variable of exposure to viral agents during the studies. One must also keep in mind that correlation does not establish causation. Correlation does not imply causation is a phrase used in the Sciences and Statistics to emphasize that Correlation between two variables does not imply Breastfeeding for the first twelve months of life is associated with a reduction in the number, and duration of all OM infections. ^[2]

Treatment

Acute otitis media

Treatment of acute otitis media is controversial. Much of the controversy centers around the difficulty of distinguishing viral infection from bacterial infection and the fact that viral infection can progress to bacterial infection at any time. Primary care providers, such as general practitioners and pediatricians, often have a monocular otoscope and perhaps a tympanometer as their only diagnostic tools, which makes this distinction difficult, especially if the canal is small and there is wax in the ear that obscures a clear view of the eardrum. An Otoscope or auriscope is a medical device which is used to look into the Ears Health care providers use otoscopes to screen for illness during regular An audiometer is a machine used for evaluating hearing loss The invention of this machine is generally credited to Dr Also, an upset child's crying can cause the eardrum to look inflamed due to causing distention of the small blood vessels on it, mimicking the redness associated with otitis media. Because of a tradition of inappropriate prescribing of antibiotics for viral acute otitis media, their use has recently been condemned by many primary care practitioners for most cases of acute otitis media. Ear specialists tend to disagree with this philosophy and promote efforts to distinguish between viral and bacterial infection, so as to optimize treatment results by giving antibiotics only for bacterial infection. Acute bacterial otitis media can cause pain that leads to sleepless nights for both children and parents, can cause eardrum perforations, not all of which heal, and can spread to cause mastoiditis and/or meningitis, brain abscess, and even death if a severe infection goes untreated long enough. High fever can occur and can cause febrile seizures. Appropriate antibiotic administration prevents most such complications. On the other hand, it is generally agreed that acute otitis media that is purely viral will usually resolve without antibiotic treatment, although associated persistent middle ear effusions may require medical intervention. ^[3][4][5]

Many guidelines now suggest deferring the start of antibiotics for one to three days^[6] avoiding the need for antibiotics for two out of three children^[7] without adverse effect on longterm outcomes for those whose treatment is deferred. ^[8] First line antibiotic treatment, if warranted, is amoxicillin. Amoxicillin ( INN) or amoxycillin ( BAN) is a moderate-spectrum bacteriolytic β-lactam antibiotic used to treat Bacterial Infections If the bacteria is resistant, then amoxicillin-clavulanate or another penicillin derivative plus beta lactamase inhibitor is second line. Co-amoxiclav is the British Approved Name, in the British Pharmacopoeia, for the combination antibiotic containing amoxicillin trihydrate a β-lactam

Prior to the invention of antibiotics, severe acute otits media was mainly remedied surgically by Myringotomy. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Myringotomy is a surgical procedure in which a tiny incision is created in the Eardrum, so as to relieve pressure caused by the excessive buildup of fluid or to drain An outpatient procedure, it consists of making a small incision in the tympanic membrane to relieve pressure build-up. The tympanic membrane (also tympanum or myrinx is a thin membrane that separates the External ear from the Middle ear.

Chronic cases or with effusion

In chronic cases or with effusions present for months, surgery is sometimes performed by an otolaryngologist (ear, nose, and throat specialist) or by an otologist (ear specialist), to insert a grommet (called a "tympanostomy tube") into the eardrum to allow air to pass through into the middle ear, and thus release any pressure buildup and help clear excess fluid within. Grommets and eyelets are Metal, Plastic, or Rubber rings that are inserted into a hole made through another material tympanostomy tube (also known as a " Grommet " is a small tube inserted into the Eardrum in order to keep the Middle ear aerated for The tympanic membrane (also tympanum or myrinx is a thin membrane that separates the External ear from the Middle ear. The middle ear is the portion of the ear internal to the Eardrum, and external to the Oval window of the Cochlea.

For chronic cases (glue ear), it is possible to use the Valsalva maneuver to reestablish middle ear ventilation, although repeated use of the Valsalva maneuver can cause infected matter to enter the eye cavity and cause conjunctivitis. The Valsalva maneuver is performed by forcibly exhaling against a closed airway Conjunctivitis (commonly called " Pink Eye " or " Red Eye " in North America and " Madras eye " in India) is an inflammation

Alternative therapies

Alternatives to conventional medical approaches include chiropractic and osteopathic spinal manipulations, targeted to relieve muscle tension to enhance lymphatic flow and allow normal opening of the Eustachian tube. Chiropractic is a Health care profession that focuses on diagnosis treatment and prevention of mechanical disorders of the Musculoskeletal system, with special emphasis Such alternatives are becoming increasingly widely used. Otitis Media has also been found to respond to homeopathic remedies. This article has been the subject of edit wars and has been placed on probation ^[9]

The Eardoc treatment reduces the fluids in the middle ear by opening the Eustachian tube. The Eustachian tube (or auditory tube) is a tube that links the Pharynx to the Middle ear. Its efficiency can be viewed and tested with a tympanometer. An audiometer is a machine used for evaluating hearing loss The invention of this machine is generally credited to Dr

Gallery

Otitis media acuta - Myringitis bullosa		Influenza	Otitis media acuta
Otitis media acuta	Otitis media chronica mesotympanalis	Otitis media chronica mesotympanalis	Otitis media chronica mesotympanalis
Otitis media chronica mesotympanalis

References

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