Source: Frei C, Frei B, Zhanel
G. Upper Respiratory Tract Infections. In: DiPiro, JT, Talbert RL,
Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8001906.
Accessed July 14, 2012.
- Acute onset of inflammation of middle ear
- Three subtypes differentiated
by onset, signs and symptoms of infection, and presence of fluid
in middle ear:
- Otitis media with effusion
- Chronic otitis media
- Viral pathogens cause 40–75% of cases.
- Bacterial causes:
- 1–50% of isolates not susceptible to
- Up to 50% possess high-level penicillin resistance.
- Incidence may be declining due to use of pneumococcal conjugate
- Haemophilus influenzae 15–30%
- Half of isolates from upper respiratory tract produce
- Moraxella catarrhalis 3–20%
- 100% ofisolates from upper respiratory tract
- Usually follows viral upper respiratory tract infection
that causes eustachian tube dysfunction and mucosal swelling in
- Most common in infants and children following cold symptoms
of runny nose, nasal congestion, or cough.
- Seven-valent pneumococcal conjugate vaccine
occurrence by 6–7% during infancy
- Did not benefit older children with history of acute otitis
- Surgical insertion of tympanostomy tubes (T tubes) to prevent
recurrent otitis media
- Viral respiratory tract infection
- Nasotracheal intubation
- Rapid onset of signs and symptoms of inflammation in middle
ear that manifests clinically as one or more of the following:
- Otalgia (denoted by pulling of ear in some infants)
- Hearing loss
- If effusion (accumulation of liquid in middle ear cavity)
present, signs and symptoms of acute infection are absent.
- Otalgia in >75% of cases
may pull on ear(s).
- Hearing loss
- Fever in <25% of cases.
- More common
in younger children,
- Discolored, thickened, bulging eardrum
- Immobile eardrum
- Bilateral in 50% of
Means of Confirmation
- Clinical diagnosis
- Requires 3 criteria be met:
- Acute onset of signs and symptoms
- Middle ear effusion, indicated by:
- Bulging of tympanic membrane
- Limited or absent mobility of tympanic membrane
- Air–fluid level behind tympanic membrane
- Middle ear inflammation
- Draining or aspirated fluid:
- Gram stain
- Differentiate among subtypes of otitis media.
- Antibiotics less
effective if otitis media with effusion or chronic otitis media.
- Treat pain.
- Consider if brief observation period warranted or if disease
severity or patient characteristics require immediate antibiotic
analgesics such as acetaminophen or ibuprofen
- Eardrops with local anesthetic in addition to oral analgesics
- Decongestants or antihistamines provide minimal benefit.
- Consider antimicrobial therapy
- High percentage of children will be cured with symptomatic
- Consider delayed antibiotic treatment (48–72 hours):
- In children 6 months to 2 years of age if symptoms not
severe and diagnosis uncertain
- In children ...