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AbstractObjectivesOtitis media (OM) is one of the most frequent diseases of childhood, with a minority of children suffering from recurrent acute otitis media (rAOM) or chronic otitis media with effusion (COME), both of which are associated with significant morbidity. We investigated whether the microbiological profiling could be used to differentiate between these two conditions. MethodsChildren up to five years of age, with rAOM (n = 45) or COME (n = 129) and scheduled for tympanostomy tube insertion were enrolled in a prospective study between 2008 and 2009. Middle ear fluids (n = 119) and nasopharyngeal samples (n = 173) were collected during surgery for bacterial culture and PCR analysis to identify Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, and to detect 15 distinct respiratory viruses. ResultsThe occurrence of bacterial and viral pathogens in middle ear fluids did not significantly differ between patients suffering from rAOM and COME. In both patient cohorts, H. influenzae and rhinovirus were the predominant pathogens in the middle ear and nasopharynx. Nasopharyngeal carriage with two or three bacterial pathogens was associated with the presence of bacteria in middle ear fluid (P = 0.04). The great majority of the bacteria isolated from middle ear fluid were genetically identical to nasopharyngeal isolates from the same patient. ConclusionsBased on these results, we propose that the common perception that rAOM is associated with recurrent episodes of microbiologically mediated AOM, whereas COME is generally a sterile inflammation, should be reconsidered. KeywordsOtitis media Bacteria Viruses Cited by (0)Copyright © 2012 Elsevier Ireland Ltd. Otitis media with effusion (OME) is a collection of non-infected fluid in the middle ear space. It is also called serous or secretory otitis media (SOM). This fluid may accumulate in the middle ear as a result of a cold, sore throat or upper respiratory infection. OME is usually self-limited, which means, the fluid usually resolves on its own within 4 to 6 weeks. However, in some instances the fluid may persist for a longer period of time and cause a temporary decrease in hearing or the fluid may become infected (acute otitis media). OME is more common in children between 6 months and 3 years of age and affects more boys than girls. The condition occurs more often in the fall and winter months and is commonly underdiagnosed because of its lack of acute or obvious symptoms (compared to acute otitis media). Otitis media with effusion is usually a result of poor function of the eustachian tube, the canal that links the
middle ear with the throat area. The eustachian tube helps to equalize the pressure between the air around you and the middle ear.
While any child may develop OME, the following are some of the factors that may increase your child's risk of developing OME:
While signs of OME can vary from child to child and change in intensity, common symptoms include:
Symptoms of OME may resemble other conditions or medical problems. Always see your child's physician for an accurate diagnosis and to discuss treatment options. If you suspect your child may have OME, you should schedule an appointment with your child's pediatrician. At your child's appointment, the physician will review the child's medical history and complete a physical examination of your child including inspecting the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement. In addition, a hearing test may be ordered. The hearing levels and the findings on tympanometry may help to diagnose OME. The picture below represents the typical appearance of OME. This is what your doctor will be seeing when using an otoscope. Add OME picture. Treatment for OME depends on many factors and is tailored for each child. Please discuss your child's condition, treatment options and your preferences with your child's physician or healthcare provider. MonitoringIn most cases the fluid in OME resolves on its own within 4 to 6 weeks, so acute treatment is not needed. MedicationsIn most cases, the middle ear fluid in OME is not infected so antibiotics are not indicated. However, if your child has an upper respiratory infection accompanying the OME, antibiotics may be indicated. Antihistamines and decongestants have been shown to have no effect on OME. Ear tubes/myringotomyIf your child has OME that persists more than 2 or 3 months and there is concern that the decreased hearing associated with the fluid may be affecting speech development or school performance, your child’s physician may suggest ear tubes (myringotomy tubes) be placed in the ear(s) through a surgical procedure called myringotomy. This surgical procedure involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to allow air to enter (ventilate) the middle ear and to prevent fluid from accumulating. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to twelve months. Surgical removal of adenoidsIf your child's adenoids are infected, your child's physician may recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called the nasopharynx). Removal of the adenoids has been shown to help some children with OME. Most children with OME will recover quickly and have no long-term effects of the disorder. If your child had ear tubes inserted or surgery to removal of her adenoids, she will need ongoing monitoring to ensure proper recovery. In some cases, OME can lead to longer term issues such as:
If you have any questions about your child's condition or long-term outlook, please talk to your child's physician. How is chronic otitis media with effusion OME differentiated from acute otitis media AOM?Otitis media with effusion (OME) and acute otitis media (AOM) are two main types of otitis media (OM). OME describes the symptoms of middle ear effusion (MEE) without infection, and AOM is an acute infection of the middle ear and caused by bacteria in about 70% of cases (1).
What is the difference between acute otitis media and chronic otitis media?Chronic otitis media is not an infection. It is inflammation in the middle ear caused by fluid trapped behind the eardrum for more than 3 months. This can cause infections like acute otitis media to keep coming back. It is less painful than acute otitis media.
How is otitis media different from otitis media with effusion?Otitis media is a generic term that refers to an inflammation of the middle ear. The middle ear is the space behind the eardrum. Otitis media with effusion means there is fluid (effusion) in the middle ear, without an infection.
Is otitis media with effusion acute or chronic?OME is usually self-limited, which means, the fluid usually resolves on its own within 4 to 6 weeks. However, in some instances the fluid may persist for a longer period of time and cause a temporary decrease in hearing or the fluid may become infected (acute otitis media).
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How is chronic otitis media with effusion differentiated from acute otitis media?
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