StatPearls

StatPearls

Book. 2017 06

Authors:

Abstract
Otitis media is defined as an infection of the middle ear fluid and is the second most common pediatric diagnosis in the emergency department following upper respiratory infections. Although otitis media can occur at any age, it is most commonly seen between the ages of 6 to 24 months. Infection of the middle ear can be due to viral, bacterial or coinfection with both. The most common bacterial organisms causing otitis media are Streptococcus pneumoniae, followed by non-typeable Haemophilus influenzae (NTHi), and Moraxella catarrhalis. Following the introduction of the conjugate pneumococcal vaccines, the pneumococcal organisms have evolved to non-vaccine serotypes. The most common viral pathogens of otitis media include the respiratory syncytial virus (RSV), coronaviruses, influenza viruses, adenoviruses, human metapneumovirus, and picornaviruses. Otitis media is diagnosed clinically considering objective findings on physical exam combined with presenting signs and symptoms. Several diagnostic tools are available such as a pneumatic otoscope, tympanometry, and acoustic reflectometry to aid in the diagnosis of otitis media. Pneumatic otoscopy is the most reliable and has a higher sensitivity and specificity as compared to otoscope, tympanometry and other modalities. Treatment of otitis media with antibiotics is controversial. Without proper treatment, suppurative fluid from the middle ear can extend to the adjacent anatomical locations and result in complications such as TM perforation, mastoiditis, labyrinthitis, petrositis, meningitis, brain abscess, hearing loss, lateral and cavernous sinus thrombosis and others. Due to the controversy surrounding treatment and the risks of complications, there are guidelines in place for the treatment of OM.  In the United States, the mainstay of treatment of an established diagnosis of otitis media is high dose amoxicillin and has been found to be most beneficial in children under two years of age. Treatment in countries like the Netherlands is initially watchful waiting, and if unresolved, antibiotics are warranted. However, the concept of watchful waiting has not gained full acceptance in the United States. Analgesics such as non-steroidal drugs and acetaminophen can be used alone or in combination to achieve effective pain control in patients with otitis media.

PMID: 29262176

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