Otitis media natural history, complications and prognosis: Difference between revisions

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==Overview==
The prognosis of otitis media is usually good with or without treatment, but varies based on the classification. Acute otitis media is self-limited and usually resolves itself within 14 days, and otitis media with effusion will usually resolve itself within 3-6 months. Chronic [[suppurative]] otitis media will usually require [[surgical]] or [[antibiotic]] intervention to alleviate symptoms and resolve the disease. Acute otitis media rapidly follows the onset of [[nasopharyngitis]]; otitis media with effusion and chronic suppurative otitis media may develop following the resolution of acute otitis media symptoms and have a longer symptomatic duration. Complications of otitis media result from the spread of causative [[infection]], as well as damage to the [[tympanic]] membrane due to fluid buildup and pressure changes. Presence of complications can increase the morbidity in otitis media patients and worsen the prognosis.


==Natural History==
==Natural History==
Typically, acute otitis media follows a cold, after a few days of a stuffy nose the ear becomes involved and can cause severe pain. The pain will usually settle within a day or two, but can last over a week. Sometimes the ear drum ruptures, discharging pus from the ear, but the ruptured drum will usually heal rapidly.
*Onset of otitis media rapidly follows the onset of the causative [[nasopharyngitis]].<ref name="pmid24400296">{{cite journal |vauthors=Coticchia JM, Chen M, Sachdeva L, Mutchnick S |title=New paradigms in the pathogenesis of otitis media in children |journal=Front Pediatr |volume=1 |issue= |pages=52 |year=2013 |pmid=24400296 |pmc=3874850 |doi=10.3389/fped.2013.00052 |url=}}</ref>
**Otitis media onset manifests through symptoms including [[ear pain]], [[fever]], [[tympanic]] effusion, [[headache]], [[cough]], and [[nasal discharge]].
*Without treatment, acute otitis media (AOM) will usually resolve between 7 and 14 days.<ref name="RosenfeldKay2010">{{cite journal|last1=Rosenfeld|first1=Richard M.|last2=Kay|first2=David|title=Natural history of untreated otitis media|journal=The Laryngoscope|volume=113|issue=10|year=2010|pages=1645–1657|issn=0023852X|doi=10.1097/00005537-200310000-00004}}</ref>
**80% of children with AOM will experience symptomatic relief without treatment within 2-3 days.
*[[Otorrhea]] will usually take longer than symptoms such as [[fever]] or [[ear pain]] to resolve.<ref name="RosenfeldKay2010">{{cite journal|last1=Rosenfeld|first1=Richard M.|last2=Kay|first2=David|title=Natural history of untreated otitis media|journal=The Laryngoscope|volume=113|issue=10|year=2010|pages=1645–1657|issn=0023852X|doi=10.1097/00005537-200310000-00004}}</ref>
*Otitis media with effusion (OME) will resolve itself without treatment in a period of 3-6 months.<ref name="RosenfeldKay2010">{{cite journal|last1=Rosenfeld|first1=Richard M.|last2=Kay|first2=David|title=Natural history of untreated otitis media|journal=The Laryngoscope|volume=113|issue=10|year=2010|pages=1645–1657|issn=0023852X|doi=10.1097/00005537-200310000-00004}}</ref>
**Complete clearance of [[middle ear]] effusion will take longer than symptomatic effects of otitis media due to longer duration of fluid drainage.
*Chronic [[suppurative]] otitis media will not usually resolve itself and will remain and recur indefinitely without [[surgical]] intervention.<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>
**Symptoms of acute otitis media will recur indefinitely, heightening risk of complications.


At an anatomic level, the typical progression of acute otitis media occurs as follows. The tissues surrounding the [[Eustachian tube]] swell due to an upper respiratory infection, allergies, or dysfunction of the tubes. The Eustachian tube remains blocked most of the time. The air present in the middle ear is slowly absorbed into the surrounding tissues. A strong negative pressure creates a vacuum in the middle ear, and eventually the vacuum reaches a point where fluid from the surrounding tissues accumulates in the middle ear. This is seen as a progression from a Type A [[tympanogram]] to a Type C to a Type B tympanogram. The fluid may become infected. It has been found that dormant bacteria behind the tympanum (eardrum) multiply when the conditions are ideal, infecting the middle ear fluid.
==Complications==
*Complications of otitis media result from the spread of causative [[infection]], as well as damage to the [[tympanic membrane]] due to fluid buildup and pressure changes.
*Intracranial and extracranial complications of otitis media include the following:<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>
**[[Meningitis]]: the pathogen causing otitis media can spread to the [[meninges]] and cause [[inflammation]].
**[[Brain abscess]]: result of [[inflammation]] from infection spreading to the [[brain]].
**[[Mastoiditis]]: infection of the [[mastoid]] [[bone]] behind the [[ears]] caused by the otitis media pathogen.<ref name="urlMastoiditis: MedlinePlus Medical Encyclopedia">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/001034.htm |title=Mastoiditis: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
**Sigmoid [[sinus]] [[thrombosis]]: otitis media can result in [[thrombosis]] of the [[cerebral veins]] and [[sinuses]] in rare cases.<ref name="pmid21817936">{{cite journal |vauthors=Ropposch T, Nemetz U, Braun EM, Lackner A, Tomazic PV, Walch C |title=Management of otogenic sigmoid sinus thrombosis |journal=Otol. Neurotol. |volume=32 |issue=7 |pages=1120–3 |year=2011 |pmid=21817936 |doi=10.1097/MAO.0b013e31822a1ec0 |url=}}</ref>
**Partial [[hearing loss]].<ref name="pmid24134083">{{cite journal |vauthors=Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP |title=Otitis media: diagnosis and treatment |journal=Am Fam Physician |volume=88 |issue=7 |pages=435–40 |year=2013 |pmid=24134083 |doi= |url=}}</ref>
**Tympanic injury requiring surgical reconstruction.<ref name="pmid24134083">{{cite journal |vauthors=Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP |title=Otitis media: diagnosis and treatment |journal=Am Fam Physician |volume=88 |issue=7 |pages=435–40 |year=2013 |pmid=24134083 |doi= |url=}}</ref>
 
==Prognosis==
*The prognosis of otitis media is usually good without treatment.
**Acute otitis media will usually resolve itself within 2 weeks.
**Otitis media with effusion will usually resolve itself within 3 months.
*Prognosis of chronic suppurative otitis media without treatment varies on the presence of complications.<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>
**Complications of [[mastoiditis]] and [[meningitis]] have poor prognosis without treatment.
*With treatment, all classifications of otitis media have a good prognosis.


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}


[[Category:Needs content]]
[[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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Latest revision as of 23:30, 29 July 2020

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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

The prognosis of otitis media is usually good with or without treatment, but varies based on the classification. Acute otitis media is self-limited and usually resolves itself within 14 days, and otitis media with effusion will usually resolve itself within 3-6 months. Chronic suppurative otitis media will usually require surgical or antibiotic intervention to alleviate symptoms and resolve the disease. Acute otitis media rapidly follows the onset of nasopharyngitis; otitis media with effusion and chronic suppurative otitis media may develop following the resolution of acute otitis media symptoms and have a longer symptomatic duration. Complications of otitis media result from the spread of causative infection, as well as damage to the tympanic membrane due to fluid buildup and pressure changes. Presence of complications can increase the morbidity in otitis media patients and worsen the prognosis.

Natural History

  • Onset of otitis media rapidly follows the onset of the causative nasopharyngitis.[1]
  • Without treatment, acute otitis media (AOM) will usually resolve between 7 and 14 days.[2]
    • 80% of children with AOM will experience symptomatic relief without treatment within 2-3 days.
  • Otorrhea will usually take longer than symptoms such as fever or ear pain to resolve.[2]
  • Otitis media with effusion (OME) will resolve itself without treatment in a period of 3-6 months.[2]
    • Complete clearance of middle ear effusion will take longer than symptomatic effects of otitis media due to longer duration of fluid drainage.
  • Chronic suppurative otitis media will not usually resolve itself and will remain and recur indefinitely without surgical intervention.[3]
    • Symptoms of acute otitis media will recur indefinitely, heightening risk of complications.

Complications

Prognosis

  • The prognosis of otitis media is usually good without treatment.
    • Acute otitis media will usually resolve itself within 2 weeks.
    • Otitis media with effusion will usually resolve itself within 3 months.
  • Prognosis of chronic suppurative otitis media without treatment varies on the presence of complications.[8]
  • With treatment, all classifications of otitis media have a good prognosis.

References

  1. ↑ Coticchia JM, Chen M, Sachdeva L, Mutchnick S (2013). "New paradigms in the pathogenesis of otitis media in children". Front Pediatr. 1: 52. doi:10.3389/fped.2013.00052. PMC 3874850. PMID 24400296.
  2. ↑ 2.0 2.1 2.2 Rosenfeld, Richard M.; Kay, David (2010). "Natural history of untreated otitis media". The Laryngoscope. 113 (10): 1645–1657. doi:10.1097/00005537-200310000-00004. ISSN 0023-852X.
  3. ↑ "www.who.int" (PDF).
  4. ↑ 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.
  5. ↑ "Mastoiditis: MedlinePlus Medical Encyclopedia".
  6. ↑ Ropposch T, Nemetz U, Braun EM, Lackner A, Tomazic PV, Walch C (2011). "Management of otogenic sigmoid sinus thrombosis". Otol. Neurotol. 32 (7): 1120–3. doi:10.1097/MAO.0b013e31822a1ec0. PMID 21817936.
  7. ↑ 7.0 7.1 Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP (2013). "Otitis media: diagnosis and treatment". Am Fam Physician. 88 (7): 435–40. PMID 24134083.
  8. ↑ Acuin J (2007). "Chronic suppurative otitis media". BMJ Clin Evid. 2007. PMC 2943814. PMID 19454051.

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