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==Overview==
==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.
Otitis media can be classified into acute, effusive, and chronic [[suppurative]] forms. Their clinical presentations will vary based on the different symptoms. The treatment necessity will also vary based on classification.


==Classification==
==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.
Otitis media can be divided into 3 subtypes, differentiating in their clinical presentation.
 
===Acute Otitis Media===
===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 102<sup>o</sup>F 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 cause[[meningitis]].
*Acute otitis media (AOM) is primarily caused by [[viral]] or [[bacterial]] infection due to [[nasopharyngitis]].<ref name="pmid24453496">{{cite journal |vauthors=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M |title=Update on otitis media - prevention and treatment |journal=Infect Drug Resist |volume=7 |issue= |pages=15–24 |year=2014 |pmid=24453496 |pmc=3894142 |doi=10.2147/IDR.S39637 |url=}}</ref>
*If caused by a [[virus]], it is usually [[self-limited]] and will typically resolve itself without treatment.<ref name="urlEar infection - acute: MedlinePlus Medical Encyclopedia">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/000638.htm |title=Ear infection - acute: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*[[Antibiotics]] may be necessary for AOM caused by [[bacterial]] infection.
*Symptoms are usually present and are similar to those from [[upper respiratory infection]], include the following:
**[[Fever]]
**Ear pain
**[[Vomiting]]
**[[Diarrhea]]
**[[Common cold]] symptoms
**Mild hearing loss
*Can result in infection-based complications, such as [[meningitis]] and [[mastoiditis]].
 
===Otitis Media with Effusion===
===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.<ref>{{cite journal|author=Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM |title=Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life |journal=J. Pediatr. |volume=123 |issue=5 |pages=702–11 |year=1993 |pmid=8229477 |doi=}}</ref>
*Otitis media with effusion (OME) is non-infectiously caused otitis media based on fluid buildup in the [[eustachian tube]].<ref name="urlOtitis media with effusion: MedlinePlus Medical Encyclopedia">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/007010.htm |title=Otitis media with effusion: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*It is usually caused by irritants, allergies, or [[upper respiratory infection]] that does not infect the ear itself.
*The fluid buildup may remain trapped in the middle ear preceding or following acute otitis media.
*Symptoms usually include partial hearing loss and feelings of "fullness" in the ear, but do not usually present pain, [[common cold]] symptoms, [[fever]], or other indicators of illness that is common in AOM.
*OME is usually [[self-limited]] and does not require treatment to resolve itself.
 
===Chronic Suppurative Otitis Media===
===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.
*Chronic suppurative otitis media (CSOM) is usually classified by the persistence of [[pus]] discharge due to [[tympanic]] perforation from acute otitis media for 6-12 weeks following treatment.<ref name="urlwww.who.int">{{cite web |url=http://www.who.int/pbd/publications/Chronicsuppurativeotitis_media.pdf |title=www.who.int |format= |work= |accessdate=}}</ref>
*The symptoms are similar to those of AOM, but persist due to the resistant active bateria causing [[suppuration]] in the ear, heightening the risk of temporary and permanent hearing loss.<ref name="pmid19454051">{{cite journal |vauthors=Acuin J |title=Chronic suppurative otitis media |journal=BMJ Clin Evid |volume=2007 |issue= |pages= |year=2007 |pmid=19454051 |pmc=2943814 |doi= |url=}}</ref>
*Treatment is required and will vary due to severity:  
**[[Antibiotics]]: [[ciprofloxacin]] and [[gentamicin]]
**Mastoidectomy
**Tympanoplasty
**Middle ear irrigation
*CSOM can result in [[otorrhea]] and can be classified by visible [[pus]] discharge outside of the [[middle ear]].


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category:Inflammations]]
[[Category:Inflammations]]
[[Category:Otolaryngology]]
[[Category:Otolaryngology]]
[[Category:Otology]]
[[Category:Otology]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Otitis media can be classified into acute, effusive, and chronic suppurative forms. Their clinical presentations will vary based on the different symptoms. The treatment necessity will also vary based on classification.

Classification

Otitis media can be divided into 3 subtypes, differentiating in their clinical presentation.

Acute Otitis Media

Otitis Media with Effusion

  • Otitis media with effusion (OME) is non-infectiously caused otitis media based on fluid buildup in the eustachian tube.[3]
  • It is usually caused by irritants, allergies, or upper respiratory infection that does not infect the ear itself.
  • The fluid buildup may remain trapped in the middle ear preceding or following acute otitis media.
  • Symptoms usually include partial hearing loss and feelings of "fullness" in the ear, but do not usually present pain, common cold symptoms, fever, or other indicators of illness that is common in AOM.
  • OME is usually self-limited and does not require treatment to resolve itself.

Chronic Suppurative Otitis Media

  • Chronic suppurative otitis media (CSOM) is usually classified by the persistence of pus discharge due to tympanic perforation from acute otitis media for 6-12 weeks following treatment.[4]
  • The symptoms are similar to those of AOM, but persist due to the resistant active bateria causing suppuration in the ear, heightening the risk of temporary and permanent hearing loss.[5]
  • Treatment is required and will vary due to severity:
  • CSOM can result in otorrhea and can be classified by visible pus discharge outside of the middle ear.

References

  1. ↑ Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M (2014). "Update on otitis media - prevention and treatment". Infect Drug Resist. 7: 15–24. doi:10.2147/IDR.S39637. PMC 3894142. PMID 24453496.
  2. ↑ "Ear infection - acute: MedlinePlus Medical Encyclopedia".
  3. ↑ "Otitis media with effusion: MedlinePlus Medical Encyclopedia".
  4. ↑ "www.who.int" (PDF).
  5. ↑ Acuin J (2007). "Chronic suppurative otitis media". BMJ Clin Evid. 2007. PMC 2943814. PMID 19454051.

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