Otitis media
Inflammation of the middle ear / From Wikipedia, the free encyclopedia
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Otitis media is a group of inflammatory diseases of the middle ear.[2] One of the two main types is acute otitis media (AOM),[3] an infection of rapid onset that usually presents with ear pain.[1] In young children this may result in pulling at the ear, increased crying, and poor sleep.[1] Decreased eating and a fever may also be present.[1] The other main type is otitis media with effusion (OME), typically not associated with symptoms,[1] although occasionally a feeling of fullness is described;[4] it is defined as the presence of non-infectious fluid in the middle ear which may persist for weeks or months often after an episode of acute otitis media.[4] Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in a perforated tympanic membrane with discharge from the ear for more than six weeks.[7] It may be a complication of acute otitis media.[4] Pain is rarely present.[4] All three types of otitis media may be associated with hearing loss.[2][3] If children with hearing loss due to OME do not learn sign language, it may affect their ability to learn.[8]
Otitis media | |
---|---|
Other names | Otitis media with effusion: serous otitis media, secretory otitis media |
A bulging tympanic membrane which is typical in a case of acute otitis media | |
Specialty | Otorhinolaryngology |
Symptoms | Ear pain, fever, hearing loss[1][2] |
Types | Acute otitis media, otitis media with effusion, chronic suppurative otitis media[3][4] |
Causes | Viral, bacterial[4] |
Risk factors | Smoke exposure, daycare[4] |
Prevention | Vaccination, breastfeeding[1] |
Medication | Paracetamol (acetaminophen), ibuprofen, benzocaine ear drops[1] |
Frequency | 471 million (2015)[5] |
Deaths | 3,200 (2015)[6] |
The cause of AOM is related to childhood anatomy and immune function.[4] Either bacteria or viruses may be involved.[4] Risk factors include exposure to smoke, use of pacifiers, and attending daycare.[4] It occurs more commonly among indigenous Australians and those who have cleft lip and palate or Down syndrome.[4][9] OME frequently occurs following AOM and may be related to viral upper respiratory infections, irritants such as smoke, or allergies.[3][4] Looking at the eardrum is important for making the correct diagnosis.[10] Signs of AOM include bulging or a lack of movement of the tympanic membrane from a puff of air.[1][11] New discharge not related to otitis externa also indicates the diagnosis.[1]
A number of measures decrease the risk of otitis media including pneumococcal and influenza vaccination, breastfeeding, and avoiding tobacco smoke.[1] The use of pain medications for AOM is important.[1] This may include paracetamol (acetaminophen), ibuprofen, benzocaine ear drops, or opioids.[1] In AOM, antibiotics may speed recovery but may result in side effects.[12] Antibiotics are often recommended in those with severe disease or under two years old.[11] In those with less severe disease they may only be recommended in those who do not improve after two or three days.[11] The initial antibiotic of choice is typically amoxicillin.[1] In those with frequent infections tympanostomy tubes may decrease recurrence.[1] In children with otitis media with effusion antibiotics may increase resolution of symptoms, but may cause diarrhoea, vomiting and skin rash.[13]
Worldwide AOM affects about 11% of people a year (about 325 to 710 million cases).[14][15] Half the cases involve children less than five years of age and it is more common among males.[4][14] Of those affected about 4.8% or 31 million develop chronic suppurative otitis media.[14] The total number of people with CSOM is estimated at 65–330 million people.[16] Before the age of ten OME affects about 80% of children at some point.[4] Otitis media resulted in 3,200 deaths in 2015 – down from 4,900 deaths in 1990.[6][17]