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.