Acute otitis media

Causes:
1. Viruses - most commonly rhinovirus, RSV and coronavirus.
2. Bacteria - Streptococcus pneumoniae, Moraxella (Branhamella) catarrhalis, H. influenzae and Streptococcus pyogenes (rare).

Pathogenesis:
Eustachian tube is port of entry for middle-ear pathogens from nasopharynx, but also is primary route of clearing middle ear secretions. This causes inflammatory edema of nasopharynx. Following this exudative and transudative fluid collect in middle ear, which allows for overgrowth of nasopharyngeal bacteria in middle ear. This suppuration may lead to spontaneous rupture, usually anterior-inferior quadrant following which discharge is seen, which is initially serosanguineous and later becomes mucopurulent.

Complications:
1. Hearing loss
2. Mastoiditis
3. Meningitis

Clinical Features:
1. Redness with bulging of tympanic membrane.
2. Mobility may be impaired.

Treatment:
A: Medical
1. Analgesics (ibuprofen and acetaminophen)
2. Antibiotics (amoxicillin is drug of choice)
3. Decongestants and/or Antihistamines (not in children)

B: Surgical
1. Tympanostomy tubes reduce recurrences of otitis media when middle ear effusion present.
2. Myringotomy to drain the pus.
3. Adenoidectomy is not very effective.