From the Guidelines
The most common cause of otitis media in a child is Streptococcus pneumoniae, followed by Haemophilus influenzae and Moraxella catarrhalis. These bacterial pathogens typically infect the middle ear after a viral upper respiratory infection compromises the function of the Eustachian tube 1. The Eustachian tube, which connects the middle ear to the back of the throat, normally ventilates and drains the middle ear, but when it becomes blocked or dysfunctional, fluid accumulates in the middle ear space, creating an ideal environment for bacterial growth. Children are particularly susceptible to otitis media because their Eustachian tubes are shorter, more horizontal, and functionally immature compared to adults.
Key Points
- Risk factors that increase the likelihood of otitis media include:
- Young age (peak incidence between 6-24 months)
- Daycare attendance
- Exposure to secondhand smoke
- Bottle feeding while lying down
- Pacifier use
- Symptoms typically include:
- Ear pain
- Irritability
- Fever
- Hearing difficulty
- Sometimes drainage from the ear if the tympanic membrane ruptures
- Treatment often involves antibiotics such as amoxicillin (40-90 mg/kg/day divided twice daily for 5-10 days) for bacterial cases, though watchful waiting may be appropriate in certain cases for children over 2 years with mild symptoms 1.
Diagnosis and Management
Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane for AOM and hearing loss for OME 1. 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 tubes primarily for children with chronic effusions and hearing loss, developmental delays, or learning difficulties.
From the Research
Causes of Otitis Media in Children
The most common causes of otitis media in children are bacterial infections. The following bacteria are commonly associated with otitis media:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- Alloiococcus otitidis (in cases of otitis media with effusion) 2, 3, 4, 5, 6
Bacterial Pathogens
The bacterial pathogens that cause otitis media can vary depending on the population and region. However, the most common pathogens are:
- Streptococcus pneumoniae: a common cause of acute otitis media, with a high prevalence of penicillin-resistant strains 2, 4, 6
- Haemophilus influenzae: a common cause of acute otitis media, with a high prevalence of beta-lactamase-producing strains 2, 4, 5, 6
- Moraxella catarrhalis: a common cause of acute otitis media, with a high prevalence of beta-lactamase-producing strains 2, 4, 5, 6
- Alloiococcus otitidis: a common cause of otitis media with effusion, particularly in children with recurrent or chronic otitis media 3
Viral Upper Respiratory Tract Infections
Viral upper respiratory tract infections can also contribute to the development of otitis media in children. The presence of a virus can increase the density and frequency of colonization with bacterial pathogens, making it more likely for otitis media to develop 5