ear, nose, and throat disorders
Otitis Media (Acute)
Introduction
Acute otitis media is a bacterial or viral infection of the middle ear, usually accompanying an upper respiratory infection. Symptoms include otalgia, often with systemic symptoms (eg, fever, nausea, vomiting, diarrhea), especially in the very young. Diagnosis is based on otoscopy. Treatment is with analgesics and sometimes antibiotics. Although acute otitis media can occur at any age, it is most common between ages 3 months and 3 years. At this age, the eustachian tube is structurally and functionally immature—the angle of the eustachian tube is more horizontal, and the angle of the tensor veli palatini muscle and the cartilaginous eustachian tube makes the opening mechanism less efficient. The etiology of acute otitis media may be viral or bacterial. Viral infections are often complicated by secondary bacterial infection. In neonates, gram-negative enteric bacilli, particularlyEscherichia coli, andStaphylococcus aureuscause acute otitis media. In older infants and children<14 years, the most common organisms areStreptococcus pneumoniae,Moraxella (Branhamella) catarrhalis, and nontypeableHaemophilus influenzae; less common causes are group A beta-hemolytic streptococci andS. aureus. In patients>14 years,S. pneumoniae,group A beta-hemolytic streptococci, andS. aureusare most common, followed byH. influenzae. 