Eustachian tube dysfunction, often in association with URIs, causes inflammation with a sterile transudate. Viral or bacterial superinfection often occurs.

• Acute otitis media: typically follows a viral URI, which can directly cause viral otitis media or, more commonly, predispose to bacterial otitis media
  • - Etiology: S. pneumoniae is isolated in up to 35% of cases; nontypable H. influenzae and M. catarrhalis are other common causes of bacterial otitis media. Concern is increasing about community-acquired methicillin-resistant S. aureus (MRSA) as an emerging etiologic agent. Viruses (e.g., RSV, influenza virus, rhinovirus, enterovirus) have been recovered either alone or with bacteria in up to 40% of cases.
  • - Clinical manifestations: The tympanic membrane is immobile, erythematous, bulging, or retracted and can perforate spontaneously.
    • Other findings may include otalgia, otorrhea, decreased hearing, and fever.
    • In isolation, erythema of the tympanic membrane is nonspecific as it is common in association with inflammation of the upper respiratory mucosa.
  • - Treatment: Indications for antibiotic treatment and regimens are listed in Table 58-2; antibiotic prophylaxis and surgical interventions offer little benefit in recurrent acute otitis media.
• Serous otitis media: Also known as otitis media with effusion, this condition can persist for weeks (e.g., acute effusions) or months (e.g., after an episode of acute otitis media) without signs of infection and is associated with significant hearing loss in the affected ear.
  • - The majority of cases resolve spontaneously within 3 months without antibiotic treatment.
  • - Antibiotic treatment or myringotomy with tympanostomy tubes is reserved for pts with bilateral effusions that have persisted for at least 3 months and are associated with significant bilateral hearing loss.
• Chronic otitis media: persistent or recurrent purulent otorrhea with tympanic membrane perforation, usually associated with conductive hearing loss
  • - Inactive disease, characterized by a central perforation of the tympanic membrane, is treated with repeated courses of topical antibiotic drops during periods of drainage.
  • - Active disease involves formation of a cholesteatoma that may enlarge and ultimately lead to erosion of bone, meningitis, and brain abscess; surgical treatment is required.
• Mastoiditis: accumulation of purulent exudate in the mastoid air cells that erodes surrounding bones and causes abscess-like cavities
  • - Pts have pain, erythema, and mastoid process swelling causing displacement of the pinna along with the signs and symptoms of otitis media.
  • - Rare complications include subperiosteal abscess, deep neck abscess, and septic thrombosis of the lateral sinus.
  • - Broad-spectrum empirical IV antibiotic regimens targeting S. pneumoniae, H. influenzae, and M. catarrhalis can be narrowed once culture results are available; mastoidectomy is reserved for complicated cases or pts in whom medical management fails.