Acute Otitis Media (Middle Ear Infection): Definition and Epidemiology

00:01 In our discussion of upper respiratory tract infections, we turn now to otitis media.

00:08 Acute otitis media is an illness marked by the rapid onset of signs and symptoms of inflammation of the middle ear.

00:19 And it is incredibly common.

00:22 By the age of three, two-thirds of kids have had at least one episode and a third of kids have had three or more.

00:36 So pediatricians know this disease very well.

00:43 As an aside, this is not a common infection in adults.

00:51 So if one of your patients is an adult and you diagnosed acute otitis media, you should question why.

01:02 Because they may well have some serious reason for abstracting the Eustachian tube.

01:12 An example would be nasopharyngeal carcinoma or some form of lymphoma.

01:19 So always worry about acute otitis media in an adult.

01:26 The highest incidence is from the ages of 6 to 24 months of age.

01:35 Males more than females perhaps because of anatomical distortion of the Eustachian tube in Down syndrome patients, they have an increased incidence.

01:48 And there are increased incidences in kids who’ve had their first episode very young.

01:56 There seems to be an increased incidence in Native Americans, in Eskimos, and Aboriginals.

02:06 So why the Eustachian tube dysfunction? Well, it’s developmental.

02:14 The Eustachian tubes of children are more horizontal and have a narrower diameter.

02:22 And of course, that increases the risk for stasis of fluid in the Eustachian tube.

02:30 Bacteria love warm static fluid and they’re able to colonize.

02:38 As a result, most of otitis media occurs as a result of respiratory tract infections.

02:47 Starts out with a viral infection causing congestion of the mucosa, of the Eustachian tube, then obstruction and the accumulation of infected secretions behind the obstruction.

03:01 Some persons who were born with a cleft palate can also have frequent episodes of acute otitis media.

03:10 And if you can imagine that a person with a cleft palate, it’s often of the soft palate.

03:17 It can extend all the way anteriorly, but it’s often of the soft palate.

03:23 So when they speak, they have a difficult time controlling secretions going up into the nasopharynx.

03:31 They’re unable to say easily the letter K for example.

03:36 So when try to say K, actually air comes out of the nasopharynx.

03:42 And that may produce secretions going up into the Eustachian tubes.

03:47 So patients with a cleft palate are predisposed.

03:51 And there are environmental reasons for there to be congestion in the Eustachian tubes.

03:58 Patients with seasonal rhinitis frequently have otitis.

04:06 Patients who are exposed to smoke of any kind.

04:12 Patients who smoke and patients who receive second-hand smoke.

04:17 And then the immunocompromised, either they develop it or they’re born with an immunodeficiency or they acquire an immunodeficiency.

04:29 So you have to be exposed to a microorganism and have a problem in the Eustachian tube viral or bacterial.