Journal Reading

Update on otitis media – prevention and

treatment
Ali Qureishi1 Yan Lee2 Katherine Belfield3 John P Birchall4 Matija Daniel2
KELOMPOK 1/
Pembimbing : dr. -

Fakultas Kedokteran Universitas Riau

Departemen Ilmu Telinga Hidung dan Tenggorokan Kepala Leher
RSUD Arifin Achmad Provinsi Riau
2019
OUTLINE
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY
DIAGNOSIS
CURRENT TREATMENT
EMERGING STRATEGIES IN PREVENTION AND TREATMENT
CONCLUSION
INTRODUCTION

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AOM OME CSOM
Acute Otitis Media Otitis Media with Efussion Chronic Supurative Otitis Media

• Usually affect • Usually affect • 22% affect children

children < 2 years children 3-7 years under 5 years old
old old • Long standing
• Acute inflammation • Middle ear suppuration of
of mastoid inflammation with middle ear
periosteum and air “Glue”-like mucin inflammation with
cells cholesteatoma

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EPIDEMIOLOGY

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 A recent worldwide systematic
review estimated that there are
709 million new cases of AOM
annually, with greater than half in
children under 5 years of age, and
found 31 million new cases of
CSOM, with 22.6% in children
under 5 years.

The review also estimated that

OM-related hearing impairment
was present in 30.82 per 10,000
population, and 21,000 deaths
were attributable to OM-related
complications.

Other worldwide studies have

estimated mortality figures as
high as 28,000 a year as a result
of OM-related complications,
mainly due to brain abscesses
and meningitis.

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ETIOLOGY

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 • Streptococcus
pneumonia
Microbial Common • Haemophilus influenza
agent
• Moraxella catarrhalis
Anatomical
Variation

Etiology
• Staphylococcus aureus
Cell biology Lesser
of Middle ear • Streptococcus
cleft and
nasopharynx common pyogenes

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DIAGNOSIS

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History, Symptoms, Examination
AOM
Short history
Fever, otalgia, irritability, otorrhea,
lethargy, anorexia, vomiting
Mild to severe bulging of tympanic
membrane with erythema
Diagnosis
OME
May occur as a residual effect of
AOM, or there may be no preceding CSOM
history
Hearing difficulties, poor attention, Permanent tympanic
behavioral problems, delayed perforation is detected
speech and language development, alongside middle ear
clumsiness, and poor balance
mucositis with or without
Otoscopy: include abnormal color persistent otorrhea;
(eg, yellow/amber/blue),
retracted/concave tympanic
membrane, and air–fluid levels.
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CURRENT TREATMENT

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AOM
In general, AOM follows a favorable course without antibiotic treatment, with
analgesia and antipyretics being important. 80% of children have spontaneous relief
of AOM within 2–14 days

Antibiotic treatment

• Aged over 6 months when unilateral or bilateral AOM is severe

• AOM is not severe but is bilateral in a child aged 6–23 months.
• non-severe unilateral AOM in a child aged 6–23 months, or non-severe unilateral/bilateral AOM in a child
aged 24 months or older, antibiotics may be prescribed or observation offered; if observation is chosen, a
mechanism should be in place to give antibiotics if symptoms do not improve in 48–72 hours.

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Current Treatment
OME CSOM
Before treatment: 3-month period of observation with
serial audiometry and assessment of the degree of
hearing loss and the impact on a child’s development
Unlike AOM and OME, the definitive
Guidelines recommend either surgery in the form of management for CSOM is usually
ventilation tubes or hearing aids. surgical

Adenoidectomy; preventeing recurrent OME

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Emerging strategies
in prevention and
treatment

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 Development in
Pneumococcal Microbiology and Drug Delivery to
Genetics
Vaccination Bacterial Middle ear
Resistance

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CONCLUSION

OME and AOM are a significant cause of patient morbidity and cost to the health service. Current
guidelines dictate their treatment, but significant shortcomings remain. Recent advances in the
fields of microbiology, biofilm study, vaccine developments, genetics, and drug delivery offer the
potential for better treatments in the future.

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Thank You

Fakultas Kedokteran Universitas Riau

Departemen Ilmu Telinga Hidung dan Tenggorokan Kepala Leher
RSUD Arifin Achmad Provinsi Riau
2019