Otitis media with effusion

Otitis media with effusion Fluid in the middle ear space with no signs or symptoms of an acute infection. 

Otitis media is an inflammation of the middle ear. Acute otitis media involves the rapid onset of signs and symptoms of inflammation in the middle ear that manifests clinically as one or more of the following otalgia (denoted by pulling of the ear in some infants), hearing loss, fever, or irritability. Otitis media with effusion (accumulation of liquid in the middle ear cavity) differs from acute otitis media in that signs and symptoms of an acute infection are absent. 

Owen, M.J., et al. (1993). Relation of infant feeding practices cigarette smoke exposure and group children care to the onset and duration of otitis media with effusion in the first years of life, J. Pediatric., 123, 702-710. 

Acute otitis media (AOM) in children is mostly caused by pneumococci and H. influenzae. It should be differentiated from otitis media with effusion (OME) in which there are no symptoms of acute infection. Furuncles of the nose are caused by S. aureus. It has to be differentiated from diphteria (in unvaccinated children) caused by Corynebac-terium diphteriae and from mononucleosis infec-tiosa caused by Epstein-Barr virus. Chronic ear infections are caused by S. aureus and gram-negative bacillae. Malignant otitis externa in diabetics is caused by P. aeruginosa. 

Antibiotic treatment of otitis media with effusion (OME) is not indicated. It is one of the most prevalent errors in the prescription of antibiotics. Despite a world-wide increase of resistant pneumococci, minor infections can still be treated with (higher) doses of penicillin. Children treated with low (inadequate) doses of antibiotics and long treatment duration were found to be colonised more frequently with resistant pneumococci. 

Antibiotics prescribed to children with chronic otitis media with effusion (OME). 

Peerless SA, Noiman AH. Etiology of otitis media with effusion antihistamines—decongestants. Laryngoscope 1980 90(11 Pt l) 1852-64. 

McLinn SE, Moskal M, Goldfarb J, Bodor F, Aronovitz G, Schwartz R, Self P, Ossi MJ. Comparison of cefuroxime axetil and amoxiciUin-clavulanate suspensions in treatment of acute otitis media with effusion in children. Antimicrob Agents Chemother 1994 38(2) 315-18. 

Estimated annual excess cases of childhood illness and death attributable to parental smoking in the United States include low birth weight (46,000 cases, 2800 perinatal deaths), sudden infant death syndrome (2,000 deaths), RSV bronchiolitis (22,000 hospitalisations, 1,100 deaths), acute otitis media (3.4 million outpatient visits), otitis media with effusion (110,000 tympanostomies), asthma (1.8 million outpatient visits, 14 deaths), and fire-related injuries (10,000 outpatient visits, 590 hospitalisations, and 250 deaths). Parental smoking was found to be an important preventable cause of morbidity and mortality among American children it results in annual direct medical expenditures of USD 4.6 billion and loss of life costs of USD 8.2 billion [298(NC)]. 

Otitis media is inflammation of the middle ear. The diagnosis of acute otitis media includes signs and symptoms of infection of the middle ear, such as otalgia, fever, and irritability, as well as the presence of fluid in the middle ear. " In otitis media with effusion, middle ear fluid is present, but signs and symptoms of infection are absent. Otitis media is most common in infants and children, 75% of whom have had at least one episode by the age of 1 year. About 20% of otitis cases occur in adults, particularly in those with a history of these infections as a child.Table 107-1 lists the risk factors for otitis media. Risk factors for otitis media owing to resistant pathogens include (1) daycare attendance, (2) prior antibiotic exposure, and (3) age younger than 2 years. " ... 

Acute otitis media must be distinguished from otitis media with effusion. Antimicrobials are indicated only in the former unless the effusion persists beyond 3 months in otitis media with effusion. Middle ear effusion in acute otitis media tends to continue after antimicrobial therapy is completed but does not require retreatment. 

American Academy of Pediatrics. Managing otitis media with effusion Practice guideline. Pediatrics 1994 94 5. 

The 4-year-old child with otitis media with effusion is not prescribed systemic antibiotics. The mother asks the nurse, Why didn t the doctor order antibiotics for my child Which statement is the nurse s best response ... 

Otitis media with effusion differs from aeute otitis media in that there are no signs of aeute infeetion. If there are no signs of infeetion, sueh as fever or pain, the nurse should explain that, with the emergenee of antimierobial-resistant... 

This is the most appropriate response. A myringotomy with insertion of tympanostomy tubes is performed on children with persistent ear infections despite antibiotic therapy or otitis media with effusion for more than 3 months with associated hearing loss. 

There is little chance that the sterile ear drops that are normally used, will actually reach the middle ear. These ear drops are applied for indications where the drops only theoretically may reach the middle ear, such as (impending) chronic otitis media with effusion, or when a glue ear develops in a patient with grommet. A swollen middle ear mucosa or a glue ear greatly reduces the chance of... 

Hurst DS. Association of otitis media with effusion and allergy as demonstrated hy intradermal skin testing and eosinophil cationic protein levels in both middle ear effusion and mucosal biopsies. Laryngoscope 1996 106 1128-1137. 

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