A middle ear infection is referred to as otitis media. Following upper respiratory infections, it is the second most frequent pediatric diagnosis in the emergency room. Otitis media can occur at any age, but it is most frequently diagnosed between 6 and 24 months of age.
A brain abscess, mastoiditis, labyrinthitis, petrositis, meningitis, hearing loss, and lateral and cavernous sinus thrombosis can develop if suppurative fluid from the middle ear is not adequately treated and spreads to the nearby anatomical regions.
Epidemiology
Otitis media is a widespread issue affecting men more frequently than women. Due to inconsistent reporting and varying frequencies throughout various geographical regions, it is challenging to estimate the precise number of cases each year.
Between six and twelve months of age, otitis media incidence peaks, then reduce until age five. About 80% of all children will suffer from otitis media, and between 80% and 90% of all children will do so before entering school.
The prevalence of otitis media in adults is lower than in children. However, it is higher in several subgroups, including those with a history of recurrent otitis media in childhood, cleft palate or immunocompromised state.
Anatomy
Pathophysiology
After a viral respiratory tract infection that affects the nasopharynx, Eustachian tubes, and middle ear mucosa, otitis media develops as an inflammatory process. The edema blocks the thinnest part of the Eustachian tube, which reduces ventilation because of the constrained anatomical space of the middle ear.
This sets off a series of processes that cause the middle ear’s negative pressure to rise, the exudate from the inflamed mucosa to thicken, and the accumulation of mucosal secretions, which promotes the colonization of viral and bacterial species.
Suppuration of open purulence in the middle ear space result from the proliferation of these bacteria in the middle ear. An erythematous or bulging tympanic membrane and purulent middle ear fluid serve as clinical indicators. On pneumatic or tympanometry otoscopy, both will show reduced TM mobility.
Etiology
Environmental and infectious causes influence otitis media. Anatomical abnormalities of the palate and tensor veli palatini, genetic predisposition, hearing implants, allergies, lack of breastfeeding, a lower socioeconomic position, and a vitamin A deficiency are major risk factors.
More than 95% of cases are caused by bacterial infections, specifically Haemophilus influenza, Streptococcus pneumoniae, and Moraxella catarrhalis. Respiratory syncytial virus, rhinovirus, influenza, parainfluenza, and adenovirus are examples of viral pathogens.
Genetics
Prognostic Factors
Most otitis media patients have an excellent prognosis. Early detection and treatment have improved the prognosis of this disease since developed nations have better access to healthcare. The cornerstone of treatment is an efficient antibiotic regimen. Several prognostic variables influence the progress of the disease.
Compared to children who acquire this condition during a season other than the winter, children who appear with less than three episodes are three times more likely to have their symptoms treated with a single course of antibiotics. Children who experience complications can be challenging to treat and frequently relapse.
Despite being extremely uncommon, intratemporal and cerebral complications have high mortality rates. Prelingual otitis media in children increases the chance of mild to severe conductive hearing loss. In the first 24 months of life, children with otitis media frequently have trouble hearing sharp or high-frequency consonants, including sibilants.
Indicated in people with tympanostomy tubes caused due to acute otitis
For <6 months- Safety and efficacy are not seen
For >6 months- Instil the drops through a single-dose vial of 0.25 ml into the affected ear canal twice daily for 1 week
300 mg in single dose or two divided doses every day
Dose Adjustments
Dosing modifications Hepatic impairment
150 mg of tablet given once a day before taking food Renal impairment
150 mg of tablet given once a day before taking food
For children >6 months of age caused by Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis
For <6 months: Safety and efficacy are not seen
For ≥6 months
30 mg/kg orally as a single dose or
an alternative dosing of10 mg/kg orally each day for 3 days, or
10 mg/kg orally as a single dose on 1st day followed by 5 mg/kg on 2nd to 5th day
6 months: Safety and effectiveness are not yet proven
above 6 months:
30-mg/kg orally given once OR
Alternative dose
10 mg/kg orally once every three days OR
Day 1 dose: 10 mg/kg orally, followed by doses of 5 mg/kg on Days 2–5.
Indicated for Acute Otitis Externa, Acute Otitis Media with the Tympanostomy Tubes
Age >6 months
Four drops into the affected ear two times a day for seven days
For the acute otitis media, it is generally administered through a tympanostomy tube
Age <6 months
Safety and efficacy not established
Children: 5 to 8 mg/kg in two divided doses every day; maximum dose: 150 mg 2 times a day
Dose Adjustments
Dosing modifications Hepatic impairment
150 mg of tablet given once a day before taking food Renal impairment
150 mg of tablet given once a day before taking food
Children: 5 to 8 mg/kg in two divided doses every day; maximum dose: 150 mg 2 times a day
Dose Adjustments
Dosing modifications Hepatic impairment
150 mg of tablet given once a day before taking food Renal impairment
150 mg of tablet given once a day before taking food
Age six months-12 years-
Administer the suspension at a dosage of 15 mg/kg by oral route two times a day for ten days, with a maximum daily limit of 800 mg
Future Trends
Media Gallary
References
https://www.ncbi.nlm.nih.gov/books/NBK470332/
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A middle ear infection is referred to as otitis media. Following upper respiratory infections, it is the second most frequent pediatric diagnosis in the emergency room. Otitis media can occur at any age, but it is most frequently diagnosed between 6 and 24 months of age.
A brain abscess, mastoiditis, labyrinthitis, petrositis, meningitis, hearing loss, and lateral and cavernous sinus thrombosis can develop if suppurative fluid from the middle ear is not adequately treated and spreads to the nearby anatomical regions.
Otitis media is a widespread issue affecting men more frequently than women. Due to inconsistent reporting and varying frequencies throughout various geographical regions, it is challenging to estimate the precise number of cases each year.
Between six and twelve months of age, otitis media incidence peaks, then reduce until age five. About 80% of all children will suffer from otitis media, and between 80% and 90% of all children will do so before entering school.
The prevalence of otitis media in adults is lower than in children. However, it is higher in several subgroups, including those with a history of recurrent otitis media in childhood, cleft palate or immunocompromised state.
After a viral respiratory tract infection that affects the nasopharynx, Eustachian tubes, and middle ear mucosa, otitis media develops as an inflammatory process. The edema blocks the thinnest part of the Eustachian tube, which reduces ventilation because of the constrained anatomical space of the middle ear.
This sets off a series of processes that cause the middle ear’s negative pressure to rise, the exudate from the inflamed mucosa to thicken, and the accumulation of mucosal secretions, which promotes the colonization of viral and bacterial species.
Suppuration of open purulence in the middle ear space result from the proliferation of these bacteria in the middle ear. An erythematous or bulging tympanic membrane and purulent middle ear fluid serve as clinical indicators. On pneumatic or tympanometry otoscopy, both will show reduced TM mobility.
Environmental and infectious causes influence otitis media. Anatomical abnormalities of the palate and tensor veli palatini, genetic predisposition, hearing implants, allergies, lack of breastfeeding, a lower socioeconomic position, and a vitamin A deficiency are major risk factors.
More than 95% of cases are caused by bacterial infections, specifically Haemophilus influenza, Streptococcus pneumoniae, and Moraxella catarrhalis. Respiratory syncytial virus, rhinovirus, influenza, parainfluenza, and adenovirus are examples of viral pathogens.
Most otitis media patients have an excellent prognosis. Early detection and treatment have improved the prognosis of this disease since developed nations have better access to healthcare. The cornerstone of treatment is an efficient antibiotic regimen. Several prognostic variables influence the progress of the disease.
Compared to children who acquire this condition during a season other than the winter, children who appear with less than three episodes are three times more likely to have their symptoms treated with a single course of antibiotics. Children who experience complications can be challenging to treat and frequently relapse.
Despite being extremely uncommon, intratemporal and cerebral complications have high mortality rates. Prelingual otitis media in children increases the chance of mild to severe conductive hearing loss. In the first 24 months of life, children with otitis media frequently have trouble hearing sharp or high-frequency consonants, including sibilants.
Indicated in people with tympanostomy tubes caused due to acute otitis
For <6 months- Safety and efficacy are not seen
For >6 months- Instil the drops through a single-dose vial of 0.25 ml into the affected ear canal twice daily for 1 week
300 mg in single dose or two divided doses every day
Dose Adjustments
Dosing modifications Hepatic impairment
150 mg of tablet given once a day before taking food Renal impairment
150 mg of tablet given once a day before taking food
For children >6 months of age caused by Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis
For <6 months: Safety and efficacy are not seen
For ≥6 months
30 mg/kg orally as a single dose or
an alternative dosing of10 mg/kg orally each day for 3 days, or
10 mg/kg orally as a single dose on 1st day followed by 5 mg/kg on 2nd to 5th day
6 months: Safety and effectiveness are not yet proven
above 6 months:
30-mg/kg orally given once OR
Alternative dose
10 mg/kg orally once every three days OR
Day 1 dose: 10 mg/kg orally, followed by doses of 5 mg/kg on Days 2–5.
Indicated for Acute Otitis Externa, Acute Otitis Media with the Tympanostomy Tubes
Age >6 months
Four drops into the affected ear two times a day for seven days
For the acute otitis media, it is generally administered through a tympanostomy tube
Age <6 months
Safety and efficacy not established
Children: 5 to 8 mg/kg in two divided doses every day; maximum dose: 150 mg 2 times a day
Dose Adjustments
Dosing modifications Hepatic impairment
150 mg of tablet given once a day before taking food Renal impairment
150 mg of tablet given once a day before taking food
Children: 5 to 8 mg/kg in two divided doses every day; maximum dose: 150 mg 2 times a day
Dose Adjustments
Dosing modifications Hepatic impairment
150 mg of tablet given once a day before taking food Renal impairment
150 mg of tablet given once a day before taking food
Age six months-12 years-
Administer the suspension at a dosage of 15 mg/kg by oral route two times a day for ten days, with a maximum daily limit of 800 mg
https://www.ncbi.nlm.nih.gov/books/NBK470332/
medtigo
Otitis Media
Updated :
August 24, 2023
A middle ear infection is referred to as otitis media. Following upper respiratory infections, it is the second most frequent pediatric diagnosis in the emergency room. Otitis media can occur at any age, but it is most frequently diagnosed between 6 and 24 months of age.
A brain abscess, mastoiditis, labyrinthitis, petrositis, meningitis, hearing loss, and lateral and cavernous sinus thrombosis can develop if suppurative fluid from the middle ear is not adequately treated and spreads to the nearby anatomical regions.
Otitis media is a widespread issue affecting men more frequently than women. Due to inconsistent reporting and varying frequencies throughout various geographical regions, it is challenging to estimate the precise number of cases each year.
Between six and twelve months of age, otitis media incidence peaks, then reduce until age five. About 80% of all children will suffer from otitis media, and between 80% and 90% of all children will do so before entering school.
The prevalence of otitis media in adults is lower than in children. However, it is higher in several subgroups, including those with a history of recurrent otitis media in childhood, cleft palate or immunocompromised state.
After a viral respiratory tract infection that affects the nasopharynx, Eustachian tubes, and middle ear mucosa, otitis media develops as an inflammatory process. The edema blocks the thinnest part of the Eustachian tube, which reduces ventilation because of the constrained anatomical space of the middle ear.
This sets off a series of processes that cause the middle ear’s negative pressure to rise, the exudate from the inflamed mucosa to thicken, and the accumulation of mucosal secretions, which promotes the colonization of viral and bacterial species.
Suppuration of open purulence in the middle ear space result from the proliferation of these bacteria in the middle ear. An erythematous or bulging tympanic membrane and purulent middle ear fluid serve as clinical indicators. On pneumatic or tympanometry otoscopy, both will show reduced TM mobility.
Environmental and infectious causes influence otitis media. Anatomical abnormalities of the palate and tensor veli palatini, genetic predisposition, hearing implants, allergies, lack of breastfeeding, a lower socioeconomic position, and a vitamin A deficiency are major risk factors.
More than 95% of cases are caused by bacterial infections, specifically Haemophilus influenza, Streptococcus pneumoniae, and Moraxella catarrhalis. Respiratory syncytial virus, rhinovirus, influenza, parainfluenza, and adenovirus are examples of viral pathogens.
Most otitis media patients have an excellent prognosis. Early detection and treatment have improved the prognosis of this disease since developed nations have better access to healthcare. The cornerstone of treatment is an efficient antibiotic regimen. Several prognostic variables influence the progress of the disease.
Compared to children who acquire this condition during a season other than the winter, children who appear with less than three episodes are three times more likely to have their symptoms treated with a single course of antibiotics. Children who experience complications can be challenging to treat and frequently relapse.
Despite being extremely uncommon, intratemporal and cerebral complications have high mortality rates. Prelingual otitis media in children increases the chance of mild to severe conductive hearing loss. In the first 24 months of life, children with otitis media frequently have trouble hearing sharp or high-frequency consonants, including sibilants.
https://www.ncbi.nlm.nih.gov/books/NBK470332/
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