ENT (Otorhinolaryngology) · MU Sofia

10. Acute inflammation of the middle ear.

Covers acute otitis media, from its definition and bacterial and viral causes linked to Eustachian tube dysfunction, through the predisposing factors and a classification by clinical course and by pathological stage. It then describes symptoms and otoscopic signs, tympanometry and audiometry findings, and when imaging is needed, followed by antibiotic and surgical treatment options, complications and differential diagnoses.

Inside: 7 sections · 2 labelled pictures · 15 flashcards · 3 min

Topic 10 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 7 sections, about 452 words (3 min of reading), with 15 flashcards.

In this note

  1. Acute Inflammation of the Middle Ear (Acute Otitis Media)
  2. Classification
  3. Clinical Picture
  4. Paraclinical and Radiological Examinations
  5. Treatment Options
  6. Possible Complications
  7. Differential Diagnosis

Acute Inflammation of the Middle Ear (Acute Otitis Media)

1. Definition: Acute Otitis Media (AOM) is an acute inflammation of the middle ear cleft (tympanic cavity, mastoid air cells, Eustachian tube) characterized by rapid onset of symptoms (otalgia, fever) plus signs of middle ear effusion and inflammation.

2. Etiopathogenesis: AOM is typically a bacterial infection secondary to Eustachian tube dysfunction (ETD), often following a viral upper respiratory tract infection (URTI).

Common organisms

  • Streptococcus pneumoniae (most common)
  • Haemophilus influenzae (non-typable)
  • Moraxella catarrhalis
  • Group A β-hemolytic streptococcus
  • Viruses: rhinovirus, RSV, influenza, adenovirus

Predisposing factors

  • Children aged 6 months–3 years
  • Short, wide, horizontally oriented Eustachian tube
  • Adenoid hypertrophy
  • Allergic rhinitis
  • Recent URTI

Classification

A. Based on clinical course

  • Acute: < 3 weeks
  • Subacute: 3–12 weeks
  • Recurrent AOM: ≥3 episodes in 6 months or ≥4/year

B. Based on pathological stage

  1. 1. Tubal occlusion stage (retraction of TM)
  2. 2. Hyperemia/exudation stage
  3. 3. Suppurative stage (bulging TM, severe otalgia)- may rupture spontan.
  4. 4. Perforation stage (otorrhea, pain relief)
  5. 5. Resolution/reparative stage- disc decr, TM heals, hearing improves

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