15 - Acute Otitis Media and Otitis Media With Effusion

Abstract

Acute otitis media (AOM) and otitis media with effusion (OME) are among the most common diseases in young children worldwide. The conditions are closely related, because all children have persistent middle ear effusion (MEE), also called OME, for up to several months after an AOM episode, and children with persistent OME are at increased risk for AOM recurrence. The cause of OM is multifactorial, with key factors being immaturity of the developing immune system and the eustachian tube in young children. OM typically starts with a viral-induced acute inflammatory cycle in the nasopharynx, which paves the way for viruses and/or bacteria to ascend through the eustachian tube to the middle ear. Risk factors for OM are genetic, social, and environmental. The presence of MEE is an important prerequisite for diagnosing AOM and OME. AOM is an acute infection with distinct bulging of the tympanic membrane (TM) that is often accompanied by rapid onset of signs and symptoms that may include fever, otalgia, and TM erythema. In OME these symptoms may be absent, and hearing loss caused by MEE is the most prominent symptom. Diagnostic modalities include (pneumatic) otoscopy, tympanometry, otomicroscopy, and audiometry. Symptomatic management of ear pain and fever is the cornerstone of AOM treatment, with immediate antibiotics indicated for children with severe or persistent infections, and watchful waiting with delayed antibiotics (if needed) for milder infections. Most OME resolves within 3 months of watchful waiting, with tympanostomy tubes indicated primarily for children with persistent MEE and hearing loss, speech and language delay, or learning difficulties. Adenoidectomy is considered in children aged 4 years or older with recurrent OME or AOM and in children of any age with OM and nasal symptoms.