Otitis media

Otitis media (OM) is any inflammation of the middle ear, without reference to etiology or
pathogenesis. It is very common in children. Etiology of otitis media is a multitude of
host, infectious, allergic, and environmental factors contribute to the development of OM.
There are several subtypes of OM, as follows:

Acute OM (AOM)

OM with effusion (OME)

Chronic suppurative OM

Adhesive OM
Signs and symptoms
AOM implies rapid onset of disease associated with one or more of the following
symptoms:

Otalgia

Otorrhea

Headache

Fever

Irritability

Loss of appetite

Vomiting

Diarrhea

Congenital abnormalities
1. Fistula preauricular
Preauricular cysts, pits (as shown below), fissures, and sinuses are benign
congenital malformations of the preauricular soft tissues first described by Van
Heusinger in 1864. Preauricular pits or fissures are located near the front of the
ear and mark the entrance to a sinus tract that may travel under the skin near the
ear cartilage. These tracts are lined with squamous epithelium and may sequester
to produce epithelial-lined subcutaneous cysts or may become infected, leading to
cellulitis or abscess.

2.

Microtia
Microtia is a congenital malformation of variable severity of the external and
middle ear. The microtic auricle consists of a disorganized remnant of cartilage
attached to a variable amount of soft tissue lobule, which often is displaced from a
position symmetrical with the opposite normal ear. The direction of displacement
depends on the degree of associated facial hypoplasia. Depending on the severity
of the anomaly, there may be evidence of external meatus formation. Microtia
commonly involves the external canal and middle ear; hence, hearing can be
affected. Microtia may present within a spectrum of branchial arch defects
(hemifacial microsomia, craniofacial microsomia) or may manifest as an
independent malformation.

3. Anotia
Anotia occurs when there is a complete absence of the auricle (external ear, also
called the pinna) and auditory canal. Anotia occur when the tissues that form the
auricle fail to develop during the first few weeks of pregnancy. Currently, the
exact cause of anotia have not been identified. Certain medications may increase
the risk of anotia when taken by the mother during pregnancy.

Infections
1. Otitis externa
Otitis externa (OE) is an inflammation or infection of the external auditory canal
(EAC), the auricle, or both. This condition can be found in all age groups.
Classification
OE may be classified as follows:

Acute diffuse OE - Most common form of OE, typically seen in swimmers

Acute localized OE (furunculosis) - Associated with infection of a hair follicle

Chronic OE - Same as acute diffuse OE but is of longer duration (>6 weeks)

Eczematous (eczematoid) OE - Encompasses various dermatologic conditions

(eg, atopic dermatitis, psoriasis, systemic lupus erythematosus, and eczema)
that may infect the EAC and cause OE

Necrotizing (malignant) OE - Infection that extends into the deeper tissues

adjacent to the EAC; occurs primarily in immunocompromised adults (eg,
diabetics, patients with AIDS)

Otomycosis - Infection of the ear canal from a fungal species (eg, Candida,
Aspergillus)

Signs and symptoms

The key physical finding of OE is pain upon palpation of the tragus (anterior to
ear canal) or application of traction to the pinna (the hallmark of OE). Patients
may also have the following signs and symptoms:

Otalgia - Ranges from mild to severe, typically progressing over 1-2 days

Hearing loss

Ear fullness or pressure

Erythema, edema, and narrowing of the EAC

Tinnitus

Fever (occasionally)

Itching (especially in fungal OE or chronic OE)

Severe deep pain - Immunocompromised patients may have necrotizing

(malignant) OE

Discharge - Initially, clear; quickly becomes purulent and foul-smelling

Cellulitis of the face or neck or lymphadenopathy of the ipsilateral neck

(occasionally)

Bilateral symptoms (rare)

History of exposure to or activities in water (frequently) (eg, swimming,

surfing, kayaking)

History of preceding ear trauma (usually) (eg, forceful ear cleaning, use of
cotton swabs, or water in the ear canal)

2. Mastoiditis
A purist's definition of mastoiditis includes all inflammatory processes of the
mastoid air cells of the temporal bone. As the mastoid is contiguous to and an
extension of the middle ear cleft, virtually every child or adult with acute otitis
media or chronic middle ear inflammatory disease has mastoiditis. In most cases,
the symptomatology of the middle ear predominates (eg, fever, pain, conductive
hearing loss), and the disease within the mastoid is not considered a separate
entity.

3.

Labyrinthitis
Labyrinthitis

is

an

inflammatory disorder of the

inner

ear,

Clinically,

or

labyrinth.

this

condition

produces disturbances of balance and hearing to varying degrees and may

affect one or both ears. Bacteria or viruses can cause acute inflammation of the
labyrinth in conjunction with either local or systemic infections. Autoimmune
processes may also cause labyrinthitis. Vascular ischemia may result in acute
labyrinthine dysfunction that mimics labyrinthitis. (See Etiology and Presentation.