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Otitis media

Nature Reviews Disease Primers volume 2, Article number: 16063 (2016) Cite this article

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Abstract

Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; ‘glue ear’) and chronic suppurative otitis media (CSOM). OM is among the most common diseases in young children worldwide. Although OM may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae. In developing countries, CSOM is a leading cause of hearing loss. OM can be of bacterial or viral origin; during ‘colds’, viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens that reside in the nasopharynx. Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane (eardrum) for AOM and hearing loss for OME; diagnostic modalities include (pneumatic) otoscopy, tympanometry and audiometry. Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent or recurrent infections. Management of OME largely consists of watchful waiting, with ventilation (tympanostomy) tubes primarily for children with chronic effusions and hearing loss, developmental delays or learning difficulties. The role of hearing aids to alleviate symptoms of hearing loss in the management of OME needs further study. Insertion of ventilation tubes and adenoidectomy are common operations for recurrent AOM to prevent recurrences, but their effectiveness is still debated. Despite reports of a decline in the incidence of OM over the past decade, attributed to the implementation of clinical guidelines that promote accurate diagnosis and judicious use of antibiotics and to pneumococcal conjugate vaccination, OM continues to be a leading cause for medical consultation, antibiotic prescription and surgery in high-income countries.

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Figure 1: Anatomy of the human ear.
Figure 2: Global acute otitis media and chronic suppurative otitis media incidence.
Figure 3: Causal pathways for otitis media.
Figure 4: Steps in the pathogenesis of virus-induced acute otitis media.
Figure 5: Otoscopical images.
Figure 6: Tympanogram.
Figure 7: Ventilation tubes.

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Acknowledgements

A.G.M.S. leads the evidENT team at University College London (UCL), UK, which is supported by a National Institute for Health Research (NIHR), Research Professorship Award. T.C. is supported, in part, by grants R01 DC005841 and UL1 TR001439 from the US NIH.

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Authors and Affiliations

  1. evidENT, Ear Institute, University College London, Royal National Throat Nose and Ear Hospital, 330 Grays Inn Road, London, WC1X 8DA, UK

    Anne G. M. Schilder

  2. Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA

    Tasnee Chonmaitree

  3. School of Medicine and Menzies Health Institute Queensland, Griffith University, Queensland, Australia

    Allan W. Cripps

  4. Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA

    Richard M. Rosenfeld

  5. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Margaretha L. Casselbrant

  6. Department of Psychology, University of Cambridge, Cambridge, UK

    Mark P. Haggard

  7. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Anne G. M. Schilder & Roderick P. Venekamp

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  1. Anne G. M. Schilder
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  2. Tasnee Chonmaitree
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  3. Allan W. Cripps
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  7. Roderick P. Venekamp
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Contributions

Introduction (A.G.M.S. and R.P.V.); Epidemiology (M.L.C.); Mechanisms/pathophysiology (A.W.C. and T.C.); Diagnosis, screening and prevention (R.M.R. and T.C.); Management (A.G.M.S. and R.P.V.); Quality of life (M.P.H.); Outlook (all authors); Overview of Primer (A.G.M.S.).

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Correspondence to Anne G. M. Schilder.

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The authors declare no competing interests.

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Schilder, A., Chonmaitree, T., Cripps, A. et al. Otitis media. Nat Rev Dis Primers 2, 16063 (2016). https://doi.org/10.1038/nrdp.2016.63

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