Otitis media is defined as inflammation of the middle ear. Acute otitis media is usually a bacterial infection accompanied by viral upper respiratory infection. Recurrent acute otitis media is diagnosed when there are 3 or more acute episodes in 6 months, or 4 or more in 1 year. Otitis media with effusion occurs when persistent inflammation manifests as asymptomatic middle ear fluid that follows acute otitis media or arises without prior otitis media.
By age 7 years, 93% of children have 1 or more episodes of acute otitis media; 39% have 6 or more episodes. Otitis media most commonly occurs between the ages of 6-12 months; and declines after age 7 years. It is rare in adults.
Acute otitis media is considered to be caused by infection. A preceding viral upper respiratory infection produces eustachian tube dysfunction that is thought to promote bacterial infection via eustachian tube. Infectious agents include Haemophilus influenzae (20-25%); Moraxella (Branhamella) catarrhalis (10-15%); Group A streptococci (1-2%); Staphylococcus aureus (1-2%); and Sterile/non-pathogens (25-30%). Of particular interest is that acute otitis media is the last entry: the most common cause is not an infection!
Otitis media with effusion is considered to be caused by a silent bacterial infection in 20-40% of cases. Eustachian tube dysfunction thought important. Allergic causes rarely substantiated.
Risk factors include: Day care; Formula feeding; Smoking in household; Male gender; and a Family history of middle ear disease. Acute otitis media in the 1st year of life is a risk factor for recurrent episodes.
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