fbpx

Otitis Media

Updated : July 1, 2024





Background

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.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

cephalexin 

250

mg

Capsule

Orally 

every 6 hrs



cefixime 

400

mg/day

Orally 

Single dose or divided every 12hr



dexamethasone/ciprofloxacin 


Indicated for Acute Otitis Externa
Four drops into the affected ear two times a day for seven days



ciprofloxacin/fluocinolone acetonide, otic 

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



roxithromycin 

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

sulfisoxazole 

The usual adult dose required for treating this infection is 2 g of oral administration four times a day for 10 to 14 days



Dose Adjustments

Not Available

betamethasone + neomycin 

Administer 2 to 3 drops into the ear thrice or four times daily



chloroxylenol/pramoxine/zinc acetate 

Indicated in the treatment of Otitis Externa, Otitis Media
Instill this medication into the affected ear with four (4) to five (5) drops, three times daily, but not exceeding four times daily



Dose Adjustments

Limited data is available

chloroxylenol/pramoxine 

Ear infections are treated with it
Administer 4 to 5 drops into the affected ear 3 to 4 times daily
For prevention, apply 4 to 5 drops into the unaffected ear three times daily



Dose Adjustments

Limited data is available

chloroxylenol 

This drug is used to treat external ear infections (excluding ear canal infections)
It eliminates the bacteria that cause these kinds of infections, lessens the swelling, and dulls the discomfort
Apply three drops to the affected ear three to four times a day



Dose Adjustments

Limited data is available

amoxicillin and clavulanate potassium 

250 mg orally 3 times daily or 500 mg orally 2 times a day 10-14 days



gentamicin/hydrocortisone 

Put 2 to 4 drops into the infected ear for 3 to 4 times daily



 

trimethoprim

Age: >6 months
5 mg/kg orally every 12 hours
The maximum duration of therapy is 10 days
The maximum dose is 200 mg



clarithromycin 

Acute: 7.5 mg/kg oral immediate release twice a day



cephalexin 

75 - 100

mg/kg

Capsule

Orally 

every 8 hrs



azithromycin 

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



azithromycin 

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.



dexamethasone/ciprofloxacin 


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



roxithromycin 

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

roxithromycin 

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

loracarbef 

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



chloroxylenol/pramoxine/zinc acetate 

Indicated in the treatment of Otitis Externa, Otitis Media
For children aged two years and older, administer three (3) drops of this medication into the affected ear three times daily, not exceeding four times daily, due to the smaller capacity of the ear canal
For children under two years old, follow the guidance of a physician



chloroxylenol/pramoxine 

Ear infections are treated with it
Administer 4 to 5 drops into the affected ear 3 to 4 times daily
For prevention, apply 4 to 5 drops into the unaffected ear three times daily



chloroxylenol 

This drug is used to treat external ear infections (excluding ear canal infections)
It eliminates the bacteria that cause these kinds of infections, lessens the swelling, and dulls the discomfort
Apply three drops to the affected ear three to four times a day



acetic acid otic 

Indicated for Otitis Externa
:

<3 years: Safety and Efficacy not established
>3 years:
Clear the entire cerumen and detritus.
Place a cotton wick soaked in acetic acid otic solution inside the ear canal; alternatively, you can soak it after it has been placed.
Keep the wick in position for at least 24 hours and add 3-5 droplets every 5–6 hours to keep wetness.
After 24 hours, remove the wick; inject five droplets into the afflicted ear(s) three to four times per day for as long as recommended.
Because the auditory canal in children has a reduced volume, 3–4 drops may be adequate.



gentamicin/hydrocortisone 

For 13 to 18 years old:
Put 2 to 4 drops into the infected ear for 3 to 4 times daily



 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK470332/

Otitis Media

Updated : July 1, 2024




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.

cephalexin 

250

mg

Capsule

Orally 

every 6 hrs



cefixime 

400

mg/day

Orally 

Single dose or divided every 12hr



dexamethasone/ciprofloxacin 


Indicated for Acute Otitis Externa
Four drops into the affected ear two times a day for seven days



ciprofloxacin/fluocinolone acetonide, otic 

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



roxithromycin