Sandbox:Otitis media classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Otitis media may be classified according to the etiology, duration, physical examination findings, and degree of severity into 3 subtypes: acute, otitis media with effusion, and chronic suppurative otitis media.
Classification
Otitis media can be classified into many variants on the basis of etiology, duration, symptomatology, physical findings, and degree of severity. The terminology is sometimes confusing because of multiple terms being used to describe the same condition. A common misconception with ear infection is that sufferers think that a symptom is itchy ear. Although sufferers may feel discomfort, an itchy ear is not a symptom of ear infection.
Acute Otitis Media
Acute otitis media (AOM) is most often purely viral and self-limited, as is its usual accompanying viral URI. There is congestion of the ears and perhaps mild discomfort and popping, but the symptoms resolve with the underlying URI. If the middle ear, which is normally sterile, becomes contaminated with bacteria, pus and pressure in the middle ear can result, and this is called acute bacterial otitis media. Viral acute otitis media can lead to bacterial otitis media in a very short time, especially in children, but it usually does not. The individual with bacterial acute otitis media has the classic "earache", pain that is more severe and continuous and is often accompanied by fever of 102oF or more. Bacterial cases may result in perforation of the ear drum, infection of the mastoid space (mastoiditis) and in very rare cases further spread to causemeningitis.
Otitis Media with Effusion
Otitis media with effusion (OME), also called serous or secretory otitis media (SOM), is simply a collection of fluid that occurs within the middle ear space as a result of the negative pressure produced by altered Eustachian tube function. This can occur purely from a viral URI, with no pain or bacterial infection, or it can precede and/or follow acute bacterial otitis media. Fluid in the middle ear sometimes causes conductive hearing impairment, but only when it interferes with the normal vibration of the eardrum by sound waves. Over weeks and months, middle ear fluid can become very thick and glue-like (thus the name glue ear), which increases the likelihood of its causing conductive hearing impairment. Early-onset OME is associated with feeding while lying down and early entry into group child care, while parental smoking, a short period of breastfeeding and greater amounts of time spent in group child care increased the duration of OME in the first two years of life.[1]
Chronic Suppurative Otitis Media
Chronic suppurative otitis media involves a perforation (hole) in the eardrum and active bacterial infection within the middle ear space for several weeks or more. There may be enough pus that it drains to the outside of the ear (otorrhea), or the purulence may be minimal enough to only be seen on examination using a binocular microscope. This disease is much more common in persons with poor Eustachian tube function. Hearing impairment often accompanies this disease.