Otitis Media Update: Pathogenesis and Treatment

1992 ◽  
Vol 101 (1_suppl) ◽  
pp. 21-23 ◽  
Author(s):  
G. Scott Giebink
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Acute Otitis Media ◽  
Clinical Manifestations ◽  
Chronic Otitis Media ◽  
Antimicrobial Treatment ◽  
Antimicrobial Drugs ◽  
Respiratory Viral Infection ◽  
Acute Respiratory Viral Infection ◽  
Symptoms And Signs

Otitis media primarily affects children, but can also lead to lifelong sequelae. Middle ear histopathologic changes and clinical manifestations can represent any part of a disease continuum, from acute to recurrent to chronic otitis media. Acute otitis media is most often caused by an acute respiratory viral infection and secondary replication of bacteria in the middle ear space and tissues, leading to symptoms and signs of infection (ie, fever, pain, tympanic membrane erythema). Antimicrobial therapy is the mainstay of management, and clinical response to different antimicrobial drugs appears to be similar. The bacteriologic efficacy of these drugs, however, is quite variable. Clearly, antimicrobial treatment of acute otitis media, which currently is largely empiric, must be fine-tuned on the basis of patient and disease variation.

Antimicrobial Treatment of Acute Otitis Media

1994 ◽  
Vol 103 (5_suppl) ◽  
pp. 11-14 ◽  
Author(s):  
Daniel M. Canafax ◽  
G. Scott Giebink
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Antimicrobial Agents ◽  
Acute Otitis Media ◽  
Antimicrobial Treatment ◽  
Speech Delay ◽  
Significant Morbidity ◽  
Antimicrobial Drugs ◽  
Etiologic Role ◽  
History Of

Episodes of acute otitis media frequently occur in childhood and are attended by significant morbidity, such as hearing loss and possible speech delay. Bacteria play an important etiologic role in the pathogenesis of otitis media; therefore, antimicrobial agents are the cornerstone in the treatment of this disease. Many antimicrobial choices are available for treating children with acute otitis media. To choose an antimicrobial for each patient, consideration must be given to the patient's age, history of otitis media episodes, and responses to previously used antimicrobial drugs, and the regional antimicrobial susceptibility of the otitis media pathogens.

Otitis Media During Early Life: How Hazardous to Development? A Critical Review of the Evidence

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 869-873 ◽  
Author(s):  
Jack L. Paradise
Keyword(s):  
New York ◽  
Otitis Media ◽  
Middle Ear ◽  
News Media ◽  
Present Report ◽  
Acute Otitis Media ◽  
New York Times ◽  
Disease Process ◽  
The Body ◽  
Antimicrobial Drugs

In a number of recent reports1-3 developmental impairments of a lasting nature have been attributed to prolonged or repeated episodes of otitis media occurring during the first one to three years of life. The impairments described include intellectural and learning difficulties,1,2,4-8,10-13 impaired speech and language,3,5,8,9,11-13 and disturbed behavior.7,8 In some of the reports1,12 the impairments have been referred to as permanent or irreversible. These reports, having appeared in publications directed respectively to physicians,2-4,6,8-13 speech-language-hearing professionals,1-3,5 educators,11 and psychologists,7,12 and in some instances having been cited in widely disseminated professional and lay news media (reference 14; Newsweek, June 14, 1976, p 47; New York Times, Dec 26, 1978, p C2) quite naturally have aroused broad anxiety and concern. The reports also have served to provide the impetus, or the justification, not only for aggressive casefinding programs, but also, in infants and children with recognized middle-ear effusions, for early recourse to aggressive modes of treatment, most often in the form of myringotomy and tympanostomy tube insertion. The purpose of the present report is to review critically the body of evidence on which the supposed relationship between early otitis media and later developmental impairments is based. DISEASE PROCESS In the typical case of acute otitis media, pus fills the middle-ear cavity. Sooner or later the infection begins to subside—with or without the help of antimicrobial drugs—and the initially purulent middle-ear liquid changes in character, coming to resemble serum, mucus, or even glue. With continued healing the Eustachian tube gradually recovers its ventilatory function, and the middle-ear liquid eventually is resorbed, or drains, and becomes replaced by air.

Experimental otitis media after nasal inoculation of Streptococcus pneumoniae and influenza A virus in chinchillas

1980 ◽  
Vol 30 (2) ◽  
pp. 445-450
Author(s):  
G S Giebink ◽  
I K Berzins ◽  
S C Marker ◽  
G Schiffman
Keyword(s):  
Streptococcus Pneumoniae ◽  
Otitis Media ◽  
Influenza A Virus ◽  
Middle Ear ◽  
Influenza A ◽  
Acute Otitis Media ◽  
Aerobic Bacteria ◽  
Middle Ear Effusion ◽  
Respiratory Viral Infection ◽  
Ear Effusion

Otitis media developed in 67% of chinchillas inoculated intranasally with type 7 Streptococcus pneumoniae and influenza A virus. Only 4% of chinchillas inoculated with influenza alone and 21% of chinchillas inoculated with S. pneumoniae alone developed otitis media. Among the chinchillas that developed otitis media after inoculation with both pneumococcus and influenza, 73% of the affected ears contained effusion, and 27% of the affected ears showed tympanic membrane inflammation without middle ear effusion obtained on paracentesis. Although a majority of the ears with effusion yielded S. pneumoniae on culture, one-third of the effusions were sterile for aerobic bacteria. This model resembles conditions accompanying otitis media in humans and suggests that respiratory viral infection contributes significantly to the pathogenesis of acute otitis media.

Immunologic Characteristics of Cytokines in Otitis Media with Effusion

1992 ◽  
Vol 101 (10_suppl) ◽  
pp. 21-25 ◽  
Author(s):  
Tetsuo Himi ◽  
Toshio Suzuki ◽  
Hiroyuki Takezawa ◽  
Hiroyuki Kodama ◽  
Akikatsu Kataura
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Inflammatory Cells ◽  
Enzyme Linked Immunosorbent Assay ◽  
Gm Csf ◽  
Cytologic Analysis ◽  
Macrophage Colony

Levels of cytokines, interleukin (IL)–1α, IL-1β, tumor necrosis factor (TNF), and granulocyte-macrophage colony-stimulating factor (GM-CSF) were investigated in samples of the middle ear effusions (MEEs) from 144 ears with otitis media with effusion (OME) by enzyme-linked immunosorbent assay, followed by cytologic analysis. Middle ear effusions of the acute purulent type contained a significantly higher concentration of cytokines compared with normal control sera (p < .001). Cytokines were observed at lower levels in MEE in adults than in children. Tests of children at the chronic stage of MEE showed higher levels of TNF than IL-1 and GM-CSF. Meanwhile, IL-1β showed significantly higher concentrations in acute purulent types than in serous and mucoid types (p < .01). In cytologic analysis, the mean level of IL-1β was significantly higher in the neutrophil-rich group than in other groups (p < .05). Cytokines possess several biologic properties, some of which are associated not only with acute otitis media but also with chronic otitis media. This study showed that cytokines, especially IL-1β, contribute to infiltration into the middle ear by inflammatory cells. This implies that the persistent presence of cytokines in MEE could be a factor in prolonged OME.

A new technique (the NOW test) for the detection of Streptococcus pneumoniae in the effusions of otitis media

2002 ◽  
Vol 116 (7) ◽  
pp. 499-501 ◽  
Author(s):  
Howard Faden ◽  
Christopher Poje ◽  
Michael Pizzuto ◽  
Mark Nagy ◽  
Linda Brodsky
Keyword(s):  
Streptococcus Pneumoniae ◽  
Otitis Media ◽  
Middle Ear ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Urinary Antigen Test ◽  
Pneumococcal Antigen ◽  
A New Technique ◽  
Culture Positive ◽  
Culture Negative

The presence of Streptococcus pneumoniae in chronic otitis media was determined with a new antigen detection kit, the NOW test. The NOW test was originally designed as a urinary antigen test but was adapted to middle-ear effusions for the present study. Middle-ear effusions from 52 children were studied. Streptococcus pneumoniae was cultured from 10 per cent of the effusions. The NOW test was positive in 23 per cent of the effusions, 80 per cent of culture positive and 17 per cent of culture negative effusions. The NOW test proved to be rapid, simple, reliable and relatively inexpensive for the detection of pneumococcal antigen in the middle-ear effusions. This test may prove valuable for the management of children with acute otitis media who undergo tympanocentesis.

scholarly journals The Role of Otoscopy in the Diagnosis of Rare Diseases in Pediatrics. Congenital Middle Ear Cholesteatoma in the Child: Clinical Case

2021 ◽  
Vol 18 (4) ◽  
pp. 298-303
Author(s):  
Irina V. Zelenkova ◽  
Svetlana G. Gubanova ◽  
Irina V. Naumova ◽  
Viktor A. Gankovskii ◽  
Madina T. Fatakhova ◽  
...  
Keyword(s):  
Middle Ear ◽  
Clinical Case ◽  
Acute Otitis Media ◽  
Legal Regulations ◽  
Respiratory Viral Infection ◽  
Middle Ear Cholesteatoma ◽  
Middle Ear Disease ◽  
Acute Respiratory Viral Infection

The clinical recommendations “Acute respiratory viral infection (ARVI) in children" indicate that otoscopy should be a part of routine pediatric examination of each patient along with auscultation, percussion, etc. Nowadays, there are no legal regulations on which specialists can perform otoscopy. Thus, there is significant pediatricians’ interest in otoscopy, especially in diagnosis of acute otitis media (AOM) during primary examination for timely antibacterial management. Moreover, pediatricians could reveal such rare and very aggressive middle ear disease as cholesteatoma, its early diagnosis can prevent the development of any complications and determines the range and quality of rehabilitation actions.

Workshop on Effects of Otitis Media on the Child

PEDIATRICS ◽  
1983 ◽  
Vol 71 (4) ◽  
pp. 639-652
Author(s):  
Charles D. Bluestone ◽  
Jerome O. Klein ◽  
Jack L. Paradise ◽  
Heinz Eichenwald ◽  
Fred H. Bess ◽  
...  
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Current Knowledge ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Signs And Symptoms ◽  
Middle Ear Effusion ◽  
Ear Effusion

GOALS, DEFINITIONS, AND CLASSIFICATION OF OTITIS MEDIA —Charles D. Bluestone, MD The goal of this Workshop was to assess current knowledge concerning the effects of otitis media on the child. Experts in pediatrics, infectious disease, otolaryngology, audiology, speech, linguistics, and psychology met in Chicago on Aug 25, 1982 to participate in this Workshop. A summary of the discussions is presented here. Otitis media is broadly defined as an inflammation of the middle ear without reference to etiology or pathogenesis.1 Otitis media with effusion is an inflammation of the middle ear in which a collection of liquid (i.e., middle ear effusion) is present in the middle ear space (no perforation of the tympanic membrane is present). Atelectasis of the tympanic membrane, which may or may not be associated with otitis media, is defined as either collapse or retraction of the tympanic membrane. Acute otitis media implies a rapid and short onset of signs and symptoms lasting approximately 3 weeks. From 3 weeks to 3 months, the process may be resolving or subacute. If middle ear effusion persists beyond 3 months, the condition is classified as chronic otitis media with effusion. Many terms have been used for acute otitis media, such as "suppurative," "purulent," or "bacterial" otitis media; however, a "serous" effusion may also have an acute onset. Otitis media with effusion unaccompanied by signs and symptoms of acute inflammation has also had a plethora of other names: "serous," "secretory," "nonsuppurative," and "glue ear" have been the most commonly used. EPIDEMIOLOGY AND NATURAL HISTORY OF OTITIS MEDIA

Acute Otitis Media

1996 ◽  
Vol 17 (6) ◽  
pp. 191-195
Author(s):  
Suzanne Maxson ◽  
Terry Yamauchi
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Clinical Signs ◽  
Chronic Otitis Media ◽  
Sudden Onset ◽  
Purulent Discharge ◽  
Suppurative Otitis Media ◽  
Physician Visits

Definitions Acute otitis media with effusion (AOME) is a clinically identifiable, suppurative infection of the middle ear. The infection has a relatively sudden onset and short duration. It denotes inflammation of the mucoperiosteal lining of the middle ear. The inflamed tympanic membrane (TM) is bulging, opacified, or both. The condition chronic otitis media is poorly defined, but it may be categorized into two clinical entities for simplification: chronic otitis media with effusion (COME) and chronic suppurative otitis media (CSOM). COME, also known as serous or non-suppurative otitis media, is characterized by the presence of a middle ear effusion (MEE) behind an intact TM that persists for more than 2 to 3 months. It may be asymptomatic except for hearing loss. There generally are no acute clinical signs or symptoms, and the TM is not red or bulging. CSOM is characterized by chronic perforation of the TM, with purulent discharge, for a prolonged period of time, usually more than 6 weeks. There generally is an insidious clinical onset. Either COME or CSOM may follow AOME. Epidemiology Otitis media is one of the most frequent causes for physician visits by children. Approximately 25% of such visits during the first year of life are for middle ear disease; this increases to 40% for children 4 to 5 years of age.

Effect of Penicillin on Formation of Fibrous Adhesions in Acute Otitis Media

1998 ◽  
Vol 107 (9) ◽  
pp. 761-764 ◽  
Author(s):  
Per Cayé-Thomasen ◽  
Mirko Tos
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Acute Infection ◽  
General Pattern ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Middle Ear Surgery ◽  
Suppurative Otitis Media ◽  
Single Episode ◽  
Anatomic Localization

Fibrous middle ear adhesions are occasionally encountered in middle ear surgery and may cause a hearing impairment. Although usually associated with chronic otitis media, adhesions are also found following a single episode of experimental acute suppurative otitis media, suggesting a pathogenesis based on the inflammatory process engaging acute infection. In a well-established rat model of pneumococcal acute otitis media, we report on the effect of penicillin V on formation of fibrous middle ear adhesions. Previous studies have shown marked impact of penicillin on mucosal goblet cell density and other histopathologic features. Number, anatomic localization, and histopathologic morphology of adhesions were assessed in a longitudinal study of 25 normal, 25 untreated, and 25 treated rats. Although penicillin administration induced a slight tendency toward fewer ears with adhesions and fewer adhesions per ear, these changes were nonsignificant. Histomorphology and the general pattern of anatomic localization of adhesions were unaffected by penicillin administration. We conclude that administration of penicillin has an inconspicuous effect on the formation of fibrous adhesions in experimental acute otitis media caused by Streptococcus pneumoniae.

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