Otitis Media in winter: Acute Otitis Media or Otitis Media with Effusion?

Posted: Tuesday, November 2, 2010 | Posted by Debajyoti Datta | Labels: , , ,

Winter is at our doorstep and with it the incidence of viral respiratory tract infections and allergic conditions of the upper respiratory tract is on the rise. Both these conditions give rise to otitis media by blocking the Eustachian tube and impairing middle ear cavity drainage. This results in fluid accumulation which may  become infected causing acute otitis media. The incidence of otitis media with effusion is very common; almost 90% of children suffer from otitis media with effusion before school age.

anatomy of middle ear cavity and opening of Eustachian tube
Eustachian Tube
Otitis media with effusion may immediately precede an attack of acute otitis media or may follow an attack of acute otitis media. These two conditions need to be differentiated because antibiotic treatment is not always necessary in otitis media with effusion. Unnecessary antibiotic treatment may cause treatment failure and subsequent drug resistance.

Signs and Symptoms
Otitis media with effusion
Acute otitis media
Hearing Loss
Mild-to-moderate
Mild-to-moderate
Earache
Absent
Moderate-to-severe
Tenderness
Absent
Absent
Purulent drainage from ear
Absent
Only after perforation of tympanic membrane
Bacterial infection
Absent
Present
Systemic symptoms
 ( fever, malaise)
Present
Present

Otitis media with effusion generally presents with mild to moderate hearing loss, conductive in type and is not associated any pain or fever. It is diagnosed by pneumatic otoscopy in which the tympanic membrane is immobilized. Tympanometry is also a useful investigation. On examination of the infected ear, the tympanic membrane is retracted. Fluid is present behind the tympanic membrane, presence of air bubbles or air-fluid level is pathognomonic. It generally resolves without treatment.

Retracted tympanic membrane in otitis media with effusion
Retracted tympanic membrane
Acute Otitis media is sudden in onset, associated with pain in the affected ear and hearing loss, conductive in type is present. System symptoms such as fever are present. On examination, the tympanic membrane is red and bulged; rupture of the tympanic membrane provides relief to the symptoms.

Red congested tympanic membrane in acute otitis media
Red, bulged tymanic membrane in AOM
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1 comments:

  1. Richard C. Lambert said...
  2. The incidence of otitis media with effusion is very common; almost 90% of children suffer from otitis media with effusion before school age.

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