Middle ear infections

Otitis media is the second most common childhood infectious disease, exceeded in prevalence only by the common cold. It is the leading cause of visits to the doctor by children (46), and the most frequent reason why children consume antibiotics or undergo surgery in developed countries. The annual cost in Europe and the USA for the treatment of otitis media is about US $3–5 billion (8, 48), but this is probably an underestimate because of considerable indirect costs that have not been taken into consideration (2). Acute otitis media and otitis media with effusion are different versions of the otitis media disease (118, 119). Acute otitis media is defined as the presence of middle-ear effusion in conjunction with the rapid onset of one or more signs or symptoms of inflammation in the middle ear, such as pain, secretion through a perforation in the tympanic membrane, fever, or irritability (50, 114). Otitis media with effusion is defined as middle-ear effusion without signs or symptoms of an acute infection (50, 114). Thus, both disorders require middle-ear effusion for diagnosis, but the main clinical difference is the absence of acute signs or symptoms in otitis media with effusion. Otitis media with effusion may occur primarily or as a sequela to acute otitis media (1). Otitis media with effusion may show signs of active infection, despite a lack of symptoms (92). The high incidence of otitis media and the high rate of spontaneous recovery from the disease suggest that otitis media, like the common cold, is part of the gradual maturation of the child s immune system. However, untreated acute otitis media can lead to complications, such as chronic otitis media or acute mastoiditis. Chronic otitis media is defined by chronic otorrhea of more than 6 weeks duration, through a perforation of the tympanic membrane, and may or may not be associated with the presence of cholesteatoma. Hearing loss caused by otitis media may lead to behavioural changes and a delay in communicative development (24, 124). Several studies show that antibiotics and surgery have only moderate efficacy for otitis media (34, 93, 95), and antibiotics have potential drawbacks, such as a risk for increased antibiotic resistance (140). The best management of otitis media remains therefore challenging and controversial. The large number of publications on otitis media currently listed in PubMed reflects the importance of the disease and covers a wide area of research on otitis media. A PubMed search on otitis media in January 2008 identified 21,280 publications. This review will focus on selected important references from a recent article (114) that describes systematic reviews and meta-analyses published by professional organizations (34, 44, 122, 127, 132) and independent researchers (32, 37, 102, 106, 109, 110, 131, 141). Systematic reviews by the American Agency for Healthcare Research and Quality on acute otitis media and otitis media with effusion will also be utilized. The aim of the present article is to summarize the current state of knowledge about the epidemiology, pathogenesis, diagnosis, clinical management, treatment and prevention of the otitis media disease.