Acute Otitis Media
Acute otitis media is a very common cause of ear pain in children with 60 - 80% of children with one episode by 1 year of age and 80 - 90% by two to three years of age. The incidence of AOM is in decline and may be related to the increased use of the pneumococcal conjugate vaccine. Acute otitis media requires BOTH diagnostic criteria: Middle ear inflammationBudging of the tympanic membraneErythema of the tympanic membraneOtalgia Middle ear effusionTympanic membrane opacityDecreased tympanic membrane mobilityAir-fluid levelsOtorrhea Risk factors for AOM: Age: 6 and 18 monthsFamily history (relative risk 2.63)Day care attendance (relative risk 1.59, 2.45 in different studies)No breastfeeding (relative risk 0.87) - likely due to increased bacterial nasopharyngeal colonization and immunologic protective factorsTobacco smoke (relative risk 1.48)Pacifier use (relative risk 1.24)Native Americans, Alaskan and Canadian Inuit children, and indigenous Australian childrenPoverty and household crowdingFall and winter Pathogenesis (usual): Antecedent viral upper respiratory tract infection Resultant inflammatory edema of the respiratory mucosa Eustachian tube obstruction Negative middle ear pressure with resultant buildup of middle ear secretions Bacterial growth in the middle ear secretions resulting in suppurative infection
