++
Acute otitis media (AOM) is
defined as an acute illness marked by the presence of middle ear
fluid and inflammation of the mucosa that lines the middle ear space. Otitis
media with effusion (OME) is defined by
the presence of middle ear fluid without acute signs of illness
and usually follows AOM but may also occur as a result of barotrauma
or allergy. Synonyms for OME include serous otitis, secretory otitis,
glue ear, and middle ear catarrh. Less common chronic variations
of otitis media include permanent perforation of the tympanic membrane,
and perforation or retraction of the tympanic membrane with trapped
epithelium that is unable to spontaneously clear desquamated debris,
forming a cholesteatoma. This may occur in the
presence of an intact tympanic membrane. Both perforations and cholesteatoma
may be associated with recurrent foul-smelling otorrhea, termed chronic
suppurative otitis media.
++
Infection may spread from the middle ear space to contiguous
structures such as the mastoid air cells, the petrous bone, and
the inner ear. For detailed discussions of the various facets of infections
of the middle ear, the reader is referred to the text Otitis
Media in Infants and Children by the author and Charles
D. Bluestone1 and two Clinical Practice Guidelines:
Diagnosis and Management of Acute Otitis Media2 and
Otitis Media with Effusion,3 prepared by the American Academy
of Pediatrics (AAP) and the American Academy of Family Physicians.
++
Epidemiology
and Genetics
++
Acute otitis media has been a disease burden for children since
the beginning of time. Examination of Egyptian mummies revealed
perforations of the tympanic membranes and destruction of the mastoid.4 Before
the introduction of antimicrobial agents, AOM was a frequent reason
for hospitalization of infants and children; in 1932, AOM, mastoiditis,
and intracranial complications were the admitting diagnoses for
27% of pediatric admissions to Bellevue Hospital in New
York City.5 The introduction of the sulfonamides
in 1936, penicillin in the 1940s, and the many broad-spectrum antimicrobial
agents in the 1950s substantially reduced hospitalizations for suppurative
complications of AOM.
++
Previous longitudinal studies are a rich source of information
about the disease in specific populations but three factors are
likely to further alter the epidemiology of otitis media in the
United States since 2000: (1) introduction of the 7-valent conjugate
pneumococcal vaccine (PCV7) in the United States in 2000, and later
in countries throughout the world, which has reduced the number
of episodes of vaccine-type pneumococcal acute otitis media (AOM) and
decreased the incidence of severe and recurrent disease; (2) publication
of management guidelines by the American Academy of Pediatrics (AAP)
and the American Academy of Family Physicians (AAFP) in 2004, which
presented uniform criteria for diagnosis, choice of antimicrobial
agents, and recommendations for use or withholding of antimicrobial
agents for children with AOM2; and (3) programs
developed by the Centers for Disease Control (CDC) and advocacy
groups to inform physicians ...