Otitis Media

Published on 21/03/2015 by admin

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Last modified 21/03/2015

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Chapter 59 Otitis Media

PATHOPHYSIOLOGY

Acute otitis media (AOM) is an inflammation of the middle ear. Children 6 years of age and younger are at particular risk for acute otitis media because their eustachian tubes are shorter and more horizontal, and lack the cartilaginous support found in older children and adults. This allows the eustachian tubes to collapse, which causes negative pressure in the middle ear. In turn, there is impaired drainage of middle ear fluid and possible reflux of pharyngeal secretions into this normally sterile area. The eustachian tubes of infants and children with cleft palate or Down syndrome are also wider, so they remain open; this allows bacteria to travel easily from the nasopharynx into the middle ear, and this further predisposes such children to infection. Acute otitis media is the most common infection for which antibacterial agents are prescribed for children in the United States. Among childhood diseases, it is second in prevalence only to the common cold, accounting for 1 in 3 pediatric sick visits in this country and over 13 million annual prescriptions. Growing concerns about the rising rates of antibacterial resistance have prompted changes in the medical management of uncomplicated AOM. Two types of otitis media are common in clinical pediatrics: acute otitis media and otitis media with effusion.