So when you’re talking about
acute bacterial otitis media,
this is the order of the
most common causes.
Number one is Streptococcus pneumoniae.
Number two is Haemophilus influenzae.
Now remember, in developing
countries, most babies
get immunized against H.
influenzae type B.
We don’t see that as much
anymore in developed countries,
but in developing countries we do see H.
and a lot of the complications,
which include meningitis.
Many of the time, we don’t know
what’s caused the problem.
The cultures are negative or we grow
something that’s not normally pathogenic.
Moraxella is a definite cause of
acute otitis media in children,
but generally, it’s milder than
that caused by the pneumococcus.
Strep pyogenes, group A
strep, was once common.
Now, it’s uncommon.
Staph aureus is an uncommon
cause of acute otitis media,
except when we have to employ tympanostomy
tubes because of frequent recurrences.
And there are miscellaneous causes.
So here are some of the
in developing countries.
Every once in a while you
will encounter a patient with
otitis media due to
This is usually chronic, not acute.
which is a soilborne
mycobacterium, very, very unusual.
And of interest, some worms
can even cause otitis media.
The most strange example I ever
heard of that was a patient
who had Ascaris lumbricoides.
Now, Ascaris worms are about
the size of earthworms.
And this patient had a large Ascaris worm
find its way up into the Eustachian tube,
perforate the tympanic
membrane from the inside,
and the patient actually pulled the worm
out of the external auditory canal.
And then the disease
Granulomatosis with polyangiitis,
which often causes disease in
the lungs and kidneys, as well,
has been a cause
of otitis media,
and this would be one of the reasons
perhaps an adult could be diagnosed.
I’m not saying that a normal adult
couldn’t have otitis media,
just the antenna should be up
when an adult has otitis media.
Now, if you’re looking at the severity,
look no further than
It’s number one in causing bad symptoms,
it’s number one in being persistent,
and it’s number one in
the most serious of which is going
to be bacterial meningitis.
The non-typable H. flus are
milder in all of those categories
and Moraxella catarrhalis
is milder yet.
So the initial event is
the common cold, viral.
And of interest, in kids who have
actually bacterial otitis media,
you can find the viruses
in 50% of them.
They’re actually found
in the middle ear fluid
of 25% of children with
bacterial otitis media.
Among the viruses that cause this,
the most common is
respiratory syncytial virus,
influenza virus, enterovirus,
the common cold coronaviruses,
and rhinoviruses, another
cause of the common cold.