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 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The epidemiology, pathogenesis, diagnosis, complications and sequelae, and therapy of otitis media are reviewed. Otitis media is one of the most common infections in infants and children. Epidemiologic studies have identified season of the year, bottle versus breast feeding, socioeconomic status, race, sex, and daycare attendance as factors associated with the occurrence of otitis media. The condition is believed to arise secondary to eustachian tube dysfunction in the presence of viral or bacterial invasion of the nasopharynx. Diagnosis is often made by direct observation of the tympanic membrane with an otoscope. If untreated, the infection can spread to other structures in the aural cavity or even to the brain and meninges. The most frequent complication of otitis media is hearing loss, which may result in speech and learning difficulties. Oral antimicrobial agents--notably ampicillin, amoxicillin, amoxicillin-clavulanate, cefaclor, cefuroxime axetil, bacampicillin, cyclacillin, erythromycin ethylsuccinate-sulfisoxazole, cefixime, and trimethoprim-sulfamethoxazole--are the mainstay of treatment. Selection of the agent should be based primarily on its spectrum of activity against Streptococcus pneumoniae and Haemophilus influenzae. Other considerations include the presence of beta-lactamase-producing strains of H. influenzae and Branhamella catarrhalis, adverse effects, cost, and compliance. In cases of recurrent otitis media, antimicrobial prophylaxis or surgery may be indicated. Chronic otitis media with effusion may be treated with oral antimicrobials, but surgery may also be necessary. Chronic suppurative otitis media often requires hospitalization and intravenous antimicrobial therapy with agents effective against Pseudomonas aeruginosa. Oral antimicrobial agents represent the treatment of choice for otitis media, but such therapy addresses only one of the several etiologic factors identified.
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PMID:Therapy of otitis media. 240

Classic complications of untreated otitis media include meningitis, lateral sinus thrombosis and chronic suppurative otitis media. In the past, in countries where otitis media is usually treated, complications have been rare, because of the good activity of almost all orally administered antibiotics against the most common cause of complications, Streptococcus pneumoniae. Treatment failures were usually caused by beta-lactamase-producing nontypable Haemophilus influenzae or by Moraxella (Branhamella) catarrhalis and were rarely associated with serious systemic infections. With the advent of multidrug-resistant pneumococci, however, serious and fatal infections can occur in the face of our most potent antimicrobial agents. The consequences of the emergence of multidrug-resistant pneumococci are likely to include more persistent purulent otitis media, increased usage of broad-spectrum antibiotics, an increase in surgical treatment rates for otitis media and, eventually, an increase in suppurative complications of otitis media. Medical treatment failures probably already surpass eustachian tube dysfunction as the most common reason for tympanostomy tube insertion. Multidrug-resistant pneumococci may be expected to change the way in which primary and secondary care is currently administered.
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PMID:Otitis media complications and treatment failures: implications of pneumococcal resistance. 779 27

The pathogenesis of otitis media is a multifaceted process that is not completely understood. Eustachian tube dysfunction plays a central but uncertain role, as do viral and bacterial microorganisms. Of the latter, the three most important are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. This article reviews the various mechanisms of infection and the immune system's response to them.
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PMID:Mucosal immunity and bacteriology of the eustachian tube. 978 18

Waldeyer's ring is most prominent during childhood, when the size of the oro-nasopharyngeal space is not yet fully developed, but decreases spontaneously with age. In the child, enlarged tonsils and/or adenoids may cause Eustachian tube dysfunction/otitis media, rhinosinusitis, obstructive sleep apnea, voice changes, change in facial growth, swallowing problems and can affect overall quality of life. Consequently, tonsillectomy and/or adenoidectomy are among the most common surgical procedures in children. The size of the oro- and nasopharynx has been investigated in normal children with and without tonsil/adenoid hyperplasia, to assess whether or not it is the adenoid and tonsillar tissue that are enlarged and not the dimensions of the anatomic space that are reduced. Studies have supported that the nasopharyngeal space is not smaller in children with hyperplastic adenoids when compared to normal children. However, children with large obstructing tonsils have a smaller oropharyngeal diameter compared to children with small tonsils. Tonsil/adenoid hyperplasia appears to be due to an increase in the lymphoid elements. The size of the tonsil has been shown to be directly proportional to aerobic bacterial load and absolute number of B and T cells. Bacteria have been suggested in the etiology of the development of hyperplasia. Of interest is that of the different pathogens, Haemophilus influenzae in particular, has been associated with tonsil/adenoid hyperplasia. The distribution of dendritic cells, antigen presenting cells, is altered during disease, with fewer dendritic cells in the surface epithelium and more in the crypts and extrafollicular areas.
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PMID:What is wrong in chronic adenoiditis/tonsillitis anatomical considerations. 1057 91

The incidence of acute otitis media (AOM) in infants and young children has increased dramatically in recent years in the United States. AOM often follows upper respiratory tract infections due to pathogens such as respiratory syncytial virus (RSV), influenza virus, and parainfluenza virus (PIV). These viruses cause eustachian tube dysfunction that is critical to the pathogenesis of AOM. Vaccines against these viruses would likely reduce the incidence of AOM. In three previous studies, influenza virus vaccines reduced the incidence of AOM by 30% to 36%. Vaccines to prevent infections with RSV and PIV type 3 are undergoing clinical testing at this time. Streptococcus pneumoniae, nontypeable Haemophilus influenzae (NTHi), and Moraxella catarrhalis are the three most common AOM pathogens. Heptavalent pneumococcal conjugate vaccine is effective in preventing invasive disease and AOM caused by serotypes contained in the vaccine. Vaccine candidates for NTHi and M. catarrhalis are under development.
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PMID:Vaccine prevention of acute otitis media. 1189 59

Otitis media with mucoid effusion, characterized by mucous cell metaplasia in the middle ear cleft and thick fluid accumulation in the middle ear cavity, is a common otological disease that frequently affects young children. Multiple factors are involved in the development of this disease, especially middle ear infection and Eustachian tube dysfunction. In this study, in order to induce otitis media with effusion in rats, we introduced a three-step method, namely inoculation of Streptococcus pneumoniae at 10(7) colony-forming units (CFU)/ear or Haemophilus influenzae at 5 x 10(7) CFU/ear into the middle ear cavity twice at 2-week intervals, followed by Eustachian tube obstruction (ETO) for 4 and 8 weeks. Animals inoculated with phosphate-buffered saline (PBS) twice in the same manner followed by ETO served as controls. Middle ear effusion and mucosa were harvested for evaluation of carbohydrate concentrations and mucous cell density, respectively. We found that rats inoculated with S. pneumoniae twice, followed by ETO at 8 weeks, yielded the highest carbohydrate concentration in middle ear effusion and the highest goblet cell density in the middle ear cavity compared to the H. influenzae and PBS groups. It is tentatively concluded that inoculation of S. pneumoniae at 10(7) CFU/ear into the middle ear cavity of rats twice at 2-week intervals, followed by ETO for 8 weeks, is a promising animal model for otitis media with mucoid effusion which may be valuable for studying the human counterpart.
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PMID:Induction of mucous cell metaplasia in the middle ear of rats using a three-step method: an improved model for otitis media with mucoid effusion. 1193 6

Otitis media (OM) is a pervasive illness in infants and children, and many children suffer multiple episodes during the first years of life. High rates of acute otitis media (AOM) are reported in developed and emerging countries. Early onset is common in both settings. Recurrent OM is associated with several factors, including early onset of disease, having a sibling with a history of AOM and absence of breast-feeding. Early onset disease has been hypothesized to result from Eustachian tube dysfunction, immunologic naivete and immaturity, and viral upper respiratory tract infection. Nasopharyngeal colonization with bacterial otopathogens increases the likelihood of AOM and the disease is most frequent in children with viral respiratory tract infection colonized with multiple otopathogens (Streptococcus pneumoniae, nontypeable Haemophilus influenzae [NTHi], Moraxella catarrhalis), potentially as a result of inflammation resulting from competition among the bacterial species within the nasopharynx. Epidemiologic observations and studies of pathogenesis suggest that successful strategies for reducing the burden of disease will be best accomplished by targeting multiple viral and/or bacterial pathogens and preventing early onset disease. Guidelines (2004) for the treatment of AOM in children establish a clear hierarchy among the various antibacterials for the treatment of this disease. Failure to achieve early bacterial eradication during antibiotic therapy for AOM increases the clinical failure rates in AOM in young children. Most recurrent AOM episodes occurring within 1 month after successful completion of antibiotic therapy are due to new otopathogens. Failure to eradicate middle ear and/or nasopharyngeal pathogens is associated with higher rates of clinical recurrent AOM, even when the patients show clinical improvement or cure at the end of therapy for the initial episode. Optimal strategy for the prevention of AOM recurrences requires sterilization of the middle ear and eradication of nasopharyngeal carriage of otopathogens during antimicrobial therapy.
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PMID:Recent advances in otitis media. 1991 36

Acute otitis media is diagnosed in patients with acute onset, presence of middle ear effusion, physical evidence of middle ear inflammation, and symptoms such as pain, irritability, or fever. Acute otitis media is usually a complication of eustachian tube dysfunction that occurs during a viral upper respiratory tract infection. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common organisms isolated from middle ear fluid. Management of acute otitis media should begin with adequate analgesia. Antibiotic therapy can be deferred in children two years or older with mild symptoms. High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin. Children with persistent symptoms despite 48 to 72 hours of antibiotic therapy should be reexamined, and a second-line agent, such as amoxicillin/clavulanate, should be used if appropriate. Otitis media with effusion is defined as middle ear effusion in the absence of acute symptoms. Antibiotics, decongestants, or nasal steroids do not hasten the clearance of middle ear fluid and are not recommended. Children with evidence of anatomic damage, hearing loss, or language delay should be referred to an otolaryngologist.
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PMID:Otitis media: diagnosis and treatment. 2413 83