In our discussion of upper respiratory tract
infections, we turn now to otitis media.
Acute otitis media
is an illness marked by the rapid
onset of signs and symptoms
of inflammation of
the middle ear.
And it is incredibly common.
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.
So pediatricians know
this disease very well.
As an aside, this is not a
common infection in adults.
So if one of your patients is an adult
and you diagnosed acute otitis media,
you should question why.
Because they may well have some serious
reason for abstracting the Eustachian tube.
An example would be nasopharyngeal
carcinoma or some form of lymphoma.
So always worry about acute
otitis media in an adult.
The highest incidence is from the
ages of 6 to 24 months of age.
Males more than females
perhaps because of anatomical
distortion of the Eustachian tube
in Down syndrome patients, they
have an increased incidence.
there are increased incidences in kids
who’ve had their first episode very young.
There seems to be an increased
incidence in Native Americans,
in Eskimos, and Aboriginals.
So why the Eustachian
Well, it’s developmental.
The Eustachian tubes of children are more
horizontal and have a narrower diameter.
And of course, that increases the risk for
stasis of fluid in the Eustachian tube.
Bacteria love warm static fluid
and they’re able to colonize.
As a result,
most of otitis media occurs as a result
of respiratory tract infections.
Starts out with a
causing congestion of the
mucosa, of the Eustachian tube,
then obstruction and the accumulation of
infected secretions behind the obstruction.
Some persons who were born with
a cleft palate can also have
frequent episodes of
acute otitis media.
And if you can imagine
that a person with a cleft palate,
it’s often of the soft palate.
It can extend all the way anteriorly,
but it’s often of the soft palate.
So when they speak,
they have a difficult time controlling
secretions going up into the nasopharynx.
They’re unable to say easily
the letter K for example.
So when try to say K, actually air
comes out of the nasopharynx.
And that may produce secretions
going up into the Eustachian tubes.
So patients with a cleft
palate are predisposed.
And there are environmental
reasons for there
to be congestion in
the Eustachian tubes.
Patients with seasonal rhinitis
frequently have otitis.
Patients who are exposed
to smoke of any kind.
Patients who smoke and patients
who receive second-hand smoke.
And then the immunocompromised,
either they develop it
or they’re born with an immunodeficiency
or they acquire an immunodeficiency.
So you have to be exposed
to a microorganism and have
a problem in the Eustachian
tube viral or bacterial.