Otitis media is inflammation of the middle and can be categorised into Acute Otitis Media and Otitis Media with effusion (Glue Ear)
Acute Otitis Media - Active infection with recent onset with an inflamed ear drum and accompanying pain and fever. Perforation of a tympanic membrane with discharge can also result. Signs and Symptoms:
•Acute onset
•Inflammation (erythema and otalgia discomfort and clearly referable to the ear)
•Possible suppurative discharge on perforation of tympanic membrane
Otitis Media with Effusion (Glue Ear) - Occurs with the presence of fluid of middle ear without inflammation of the tympanic membrane and is a complication of previous history of acute otitis media. Signs and Symptoms:
•Mild hearing loss
•Absence of acute onset
symptoms and signs
•Middle ear effusion (fluid by
pneumatic otoscopy, air-fluid
level behind tympanic
membrane, otorrhea)
Complications
•Hearing loss and following,
social, educational and
psychological consequences
•Cholesteatoma
•Mastoiditis
•Cavernous sinus thrombosis
Risk factors, prophylaxis >>
Risk factors
Aboriginal population; age (3 months - 3 years); Eustachian tube dysfunction (due to pharyngeal anomalies e.g. cleft palate); immunosuppression, more at risk of chronic otitis media, often with purulent ear discharge; poor ciliary function to clear middle ear secretions (immotile ciliary syndrome, tobacco smoke, respiratory viruses); exposure to infection in crowded living conditions (often OME (otitis media with effusion = glue ear): fluid in the middle ear without symptoms of an acute ear infection), exposure to pathogens: pseudomonas aeruginosa, streptococcus pneumonia, Haemophilus influenzae, ear trauma, swimming.
Pathogenesis
Bacteria attach to respiratory mucosa (mainly nasopharyngeal epithelia) by expressing adhesins, which bind the organism to epithelial cell receptors. These adhesins may be part of the bacterias fimbriae or pili, fibrillae or cell wall, for example. The bacteria are then able to proliferate and grow.
Prophylaxis
Breastfeeding, vaccinations are up to date, ear and oral hygiene, ideal living conditions (better access to running water, housing conditions, nutrition and quality care), education about signs and symptoms, regular physical examinations, better medical access to rural and remote areas.
<< What is Otitis Media Investigations & Diagnosis>>
Investigation and Diagnosis
Otitis media (OM) is often diagnosed by its clinical presentation rather than results of its laboratory testing due to the classical clinical picture associated with this disease. When clinical presentation, patient history and physical examination (including otoscopy) together are not indicative of OM, further tests may be run to confirm diagnosis in suspected cases. These include:
•Tympanometry Waveform will be reduced or flattened in cases of OM
•Acoustic Reflectometry allows clinician to determine if air or fluid is filling the air canal without requiring an airtight seal of the canal
•Middle ear aspiration is warranted if the patient is toxic, immunosuppressed, or has seen no resolution with previous courses of antibiotics.
Clinicians may perform a pneumatic otoscopy, which involves blowing a puff of air onto the eardrum and observing subsequent movement to determine if there is air or fluid behind it. Hearing tests may also be ordered for patients with chronic ear infections.
When working with patients of the ATSI community, it is important to be proactive and holistic in your approach to healthcare. Sadly, Aboriginal children had the highest rates in the world of severe and persistent OM in 2001. The standard of health in ATSI communities has been deemed well above unacceptable by the WHO, which places ATSI patients in a high risk category for a number of health problems. While your ATSI patient is being seen for possible OM, a general examination and check-up is justified.
<< Risk Factors Management >>
Management
Aboriginal children are at higher risk of complications because living conditions in
Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time. 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears. The authors had no data on populations(ie: Aboriginal populations) with higher risks of complications.
Aboriginal communities are far poorer and hygiene standards are lower. Therefore, there is an increase in the spread of disease and with such widespread transmission, community apathy increases, especially with the lack of education and access to health care. It is recommended by the government that all Aboriginal children with middle ear infections should be treated with antibiotics, especially amoxycillin. There is evidence to show that there is an increase in antibiotic resistant strains of bacteria in Aboriginal communities, therefore, judicious use of antibiotics is warranted.
Prognosis
Oral antibiotics are only effective with high compliance, which is extremely poor in these communities as well as the fact that there is a lack of refrigeration in remote communities so IM or IV is recommended. Untreated otitis media in high risk groups may lead to mastoiditis, especially if inflammation and infection is protracted.
<< Investigations and Diagnosis Acknowlegement, links >>
Acknowledgement
This page is the collaborative work of Bailey Dunn, Anna-Marie Erian, Robert Harvey, Talvika Kooblal,Yan Lai, Olivia Lesslar, Mohammed Rahman and Carmel Tepper.
Some great sites tabout aboriginal health can be found on our Links page.
What is Otitis Media>>
References:
http://www.health.gov.au/internet/main/publishing.nsf/Content/E769255CE4197794CA25743C00083165/$File/opls.pdf
http://emedicine.medscape.com/article/994656-overview
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000219/frame.html
This is a great document about the current status of aboriginal health >>
<< Management
