Upper respiratory tract viral infection

End

Inflammation in the nasopharynx and eustachian tube

Increased inflammatory mediators

Increased bacterial colonization and adherence

Decreased mucociliary clearance of the nasopharynx, eustachian tube, and middle ear mucosal cells

Eustachian tube dysfunction/obstruction and development of negative middle ear pressure

Mucus production and development of middle ear effusion

Reflux of colonized otopathogens and URI viruses into the middle ear space

Immune and inflammatory responses in the middle ear space with development of purulent material

Acute otitis media signs and symptoms