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Infective otitis media — Clinical Guidelines

Overview

Infective otitis media involves inflammation of the middle ear, often leading to fluid accumulation and potential hearing impairment. Secretory otitis media (SOM), a chronic form, is characterized by persistent effusion without signs of acute infection 4.

Diagnosis

Clinical Presentation: Ear pain, hearing loss, fever, and sometimes otorrhea 2.

Physical Examination: Inspection for tympanic membrane changes, including bulging, erythema, and fluid lines 2.

Tympanometry: Measures middle ear pressure and mobility; abnormal findings suggest effusion 7.

Hearing Tests: Assess conductive hearing loss; speech reception threshold (SRT) and tympanometry results are crucial 15.

Imaging: Rarely needed but can include CT or MRI for complications or persistent cases 1.

Management

Ventilation Tubes (Grommets): Insertion to promote drainage and aeration; widely used but practice varies 12.

Antibiotics: For acute exacerbations with signs of infection; specific drug classes not detailed in abstracts 2.

Myringotomy: Surgical incision of the tympanic membrane for effusion drainage; CO2 laser myringotomy is an alternative method 10.

Observation: For asymptomatic cases or mild symptoms, watchful waiting may be appropriate 15.

Adenoidectomy: Considered in cases with recurrent or persistent SOM, especially in pediatric populations 8 14.

Special Populations

Pediatrics: Ventilation tubes are frequently used; adenoidectomy may be considered for recurrent cases 8 12 14.

Comorbidities: No specific management adjustments detailed in abstracts, but comorbidities like adenoid hypertrophy may influence treatment choices 5 14.

Key Recommendations

Use of Ventilation Tubes: Indicated for persistent secretory otitis media with hearing impairment; practice varies widely among clinicians (Evidence: Moderate) 12.

Monitoring and Watchful Waiting: Appropriate for mild cases without significant hearing loss or complications (Evidence: Expert opinion) 15.

Consider Adenoidectomy: In pediatric patients with recurrent secretory otitis media despite other interventions (Evidence: Moderate) 8 14.

References

1 Guo C, Pan L, Chen L, Xie J, Liang Z, Huang Y et al.. Investigating the epidemiological relevance of secretory otitis media and neighboring organ diseases through an Internet search. PeerJ 2024. link 2 Ghimire B, Basnet M, Aryal GR, Shrestha N. Tympanic Membrane Perforation among Patients Presenting to Department of Otorhinolaryngology of a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA; journal of the Nepal Medical Association 2022. link 3 Hussain M, Wasif M, Awan MS, Ghaloo SK, Sheikh Z, Iftikhar H. Use of endoscope in teaching of otolaryngology residents about site and size of tympanic membrane perforation and its impact on degree of hearing loss in adult patients: A cross sectional study. JPMA. The Journal of the Pakistan Medical Association 2020. link 4 Ruben RJ. Serous otitis media in the 20th and 21st centuries: evolving views and treatments. Acta oto-laryngologica 2009. link 5 Jesic S, Stojiljkovic L, Petrovic Z, Djordjevic V, Nesic V, Stosic S. Alteration of adenoid tissue alkaline and acid phosphatase in children with secretory otitis media. International journal of pediatric otorhinolaryngology 2006. link 6 Tozzi A, Blancasio AC, Basagni C, Ricci C, Burzynska J, Battaglia MA. Prevention and cure of rhinogenous deafness at the Thermal Baths "Bagni delle Galleraie". Journal of preventive medicine and hygiene 2006. link 7 Gaihede M. Mechanical properties of the middle ear system investigated by its pressure-volume relationship. Introduction to methods and selected preliminary clinical cases. Audiology & neuro-otology 1999. link 8 Pizzuto MP, Volk MS, Kingston LM. Common topics in pediatric otolaryngology. Pediatric clinics of North America 1998. link70055-9) 9 Proctor DF. Historic development and medical use of nasopharyngeal radium irradiation treatments. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1996. link 10 DeRowe A, Ophir D, Katzir A. Experimental study of CO2 laser myringotomy with a hand-held otoscope and fiberoptic delivery system. Lasers in surgery and medicine 1994. link 11 Derkay CS, Shroyer MN, Ashby J. Water precautions in children with tympanostomy tubes. American journal of otolaryngology 1992. link90052-u) 12 Smith IM, Maw AR, Dilkes M. The use of ventilation tubes in secretory otitis media: a review of consultant otolaryngologists. Clinical otolaryngology and allied sciences 1991. link 13 Kavanagh KT, Smith TR, Golden GS, Tate NP, Hinkle WG. Promotion of patient appointment compliance in indigent pediatric medical care by use of a microcomputer. The Annals of otology, rhinology, and laryngology 1989. link 14 Al-Sheikhli AR. Microbiology of the adenoids. The Journal of laryngology and otology 1980. link 15 Tos M, Poulsen G. Secretory otitis media. Late results of treatment with grommets. Archives of otolaryngology (Chicago, Ill. : 1960) 1976. link

Infective otitis media