Middle Ear, Eustachian Tube, Inflammation/Infection 

  • Author: Robert B Meek, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jun 21, 2011
 

Background

Middle ear and eustachian tube inflammation are common denominators in various clinical conditions, namely, acute otitis media (AOM), chronic otitis media with effusion (COME), and eustachian tube dysfunction (ETD).

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Pathophysiology

Acute otitis media (AOM) can be described on the cellular and molecular level as a transudation of neutrophils, serum, and inflammatory mediators into the middle ear space. This transudation is associated with mucosal edema of the middle ear and bacterial or viral infection of the eustachian tube and middle ear space.

Chronic otitis media (COM) involves a transudation of serum with less cellularity of the effusion material. The inflammatory mediators are less destructive, and bacteria and viral antigens may be less prevalent.

Anatomy of the external and middle ear. Anatomy of the external and middle ear.
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Epidemiology

Frequency

United States

Otitis media (OM) is the most common diagnosis made by office-based physicians of children younger than 15 years. Otitis media (OM) is the most common reason children are prescribed antibiotics and the most common indication for surgery in children. Otitis media (OM) accounted for 18% of physician visits from 1993-1995. Acute otitis media (AOM) accounts for 13% of all emergency room visits and 30 million clinic visits; $5,000,000 is spent annually on antibiotics for the treatment of acute otitis media (AOM).

International

Rates of otitis media (OM) equal to or higher than rates in the United States are noted internationally, especially in less developed countries. A delay is evident in the peak incidence of otitis media (OM) in European children, which may be attributable to the fact that European children enter childcare at a later age.

Mortality/Morbidity

In the era of modern medicine, middle ear infection rarely leads to mortality, except in rare cases of intracranial spread of infection.

Eustachian tube dysfunction (ETD) and chronic otitis media with effusion (COME) affect 70% of children by age 7 years and are common causes of childhood hearing loss. Morbidity from otitis media (OM) primarily stems from the effect on hearing. In most cases the conductive hearing loss is entirely reversible with medical or surgical treatment. Children may have a speech/language acquisition delay from recurrent acute otitis media (AOM) or chronic otitis media with effusion (COME).

Otitis media (OM) has not clearly been shown to affect the long-term acquisition of language skills in children; however, studies have predicted that early recurrent otitis media (OM) and chronic otitis media with effusion (COME) may be predictive of future decreases in hearing as measured by school screening tests and a decrease in overall school achievement. These findings suggest a possible long-term effect on the central auditory pathway.

Race

American Indian and Native Alaskan children, including the Inuit, have higher rates of chronic otitis media (COM) than whites. Hispanic children have higher rates of otitis media (OM) than either whites or African American children.

The prevalence of chronic suppurative otitis media (OM) is highest in Inuits of Alaska, Canada, and Greenland; Australian Aborigines; and in American Indians. High prevalence is also found in Pacific Islanders and Africans. Low prevalence is found in residents of Korea, India, and Saudi Arabia. The lowest prevalence is found in residents of the United States, United Kingdom, Denmark, and Finland.

Sex

Males have a higher prevalence of acute otitis media (AOM) and undergo myringotomies and tympanoplasties more frequently than females do.

Age

Middle ear dysfunction and eustachian tube dysfunction (ETD) are more common in the pediatric age group. Peak incidence of otitis media (OM) is in the first 2 years of life.

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Contributor Information and Disclosures
Author

Robert B Meek, MD  Consulting Staff, Department of Otolaryngology-Head and Neck Surgery, Anne Arundel Medical Center

Robert B Meek, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, and Association for Research in Otolaryngology

Disclosure: Nothing to disclose.

Specialty Editor Board

Ari J Goldsmith, MD  Chief of Pediatric Otolaryngology, Long Island College Hospital; Associate Professor, Department of Otolaryngology, Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center

Ari J Goldsmith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gregory C Allen, MD  Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

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Anatomy of the external and middle ear.
 
 
 
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