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

by John Fisher, MD
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    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.


    About the Lecture

    The lecture Acute Otitis Media (Middle Ear Infection): Definition and Epidemiology by John Fisher, MD is from the course Upper Respiratory Infections. It contains the following chapters:

    • Acute Otitis Media – Definition and Epidemiology
    • Acute Otitis Media – Pathology

    Included Quiz Questions

    1. 2/3
    2. 1/3
    3. 1/2
    4. 1/5
    5. 1/10
    1. A 18 month old boy with Trisomy 21.
    2. A 52-year-old female.
    3. A 2-year-old girl.
    4. An 8-year-old Caucasian boy who is otherwise healthy.
    5. An 18-year-old Hispanic male.
    1. Abnormal obstruction of the middle ear (ie. nasopharyngeal carcinoma)
    2. Autoimmune disorder
    3. Immunodeficiency
    4. Subclinical cleft palate
    5. Bacterial sinusitis co-infection

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

     John Fisher, MD

    John Fisher, MD


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