These infections include aspiration pneumonia, lung abscess, pulmonary empyema, and chronic otitis media and sinusitis. Complications can include sinusitis and acute otitis media. This includes impetigo, cellulitis, pneumonia, septic arthritis, and otitis externa. The incidence of otitis externa is high. MOE follows a much more chronic and indolent course than ordinary acute otitis externa. People with diabetes are at risk of a severe form of "malignant otitis externa". CSOM occurs following an upper respiratory tract infection that has led to acute otitis media. Multiple diseases have been suggested, such as mastoiditis, meningitis, or otitis exacerbated into an abscess. Complications like dental malocclusion, hydrocephalus and repeated otitis media can be observed. Specifically it is used for the treatment of strep throat, otitis media, and cellulitis. During the Tektite Project in 1969 there was a great deal of otitis externa. The common cause of all forms of otitis media is dysfunction of the Eustachian tube. It may be a complication of acute otitis media. Acute otitis media is very common in childhood. It is medically important since it causes otitis and wound infection.