Otitis media

Case report:

A three year old girl is brought by his parents to practice with violent left-sided ear pain, a purulent secretion from the ear canal and fever over 39 � C and considerable fragility. The symptoms have begun two days earlier with ear pain and fever and have gradually strengthened. Preceded by a minor infection of the upper airways. The inspection of the tympanic membrane shows a clear redness with restriction of eardrum mobility and a significant purulent secretion. Pressure pain mastoid is not, also no meningeal signs are detectable.

Comment:

The otitis media is one of the most common infectious diseases in infancy; until the age of three have 2/3 of the children go through one or more episodes of acute otitis media. The most common otitis media occurs between the 6th and 24th month of life. The accumulation of inflammatory secretion in the middle ear is often associated with a restriction of the hearing function. This liquid can be made at 70% of the children more than two weeks after onset of the disease, with 40% even after one month and 10% more than three months. Children with such middle ear secretions suffer H�reinbu�en with Dezibelverlusten by 25. Recent studies have shown, moreover, that patients may suffer delayed development in terms of their language and cognitive functions with recurrent otitis episodes.

Epidemiology:

In numerous studies with punctures the middle ear relatively uniform microbiological results were reported. Leader pneumococci are having an average of 40%, followed by Haemophilus influenzae in about 25-30% and Moraxella catarrhalis by 10%. It should be noted that in about 30% no pathogens can be detected, which recent studies in 25% of the disease point to the etiological involvement of viruses. The most common viruses are respiratory syncytial virus, influenza, enteroviruses and rhinoviruses. Not infrequently, it also comes to a mixed infection of viral and bacterial pathogens.

Therapy:

The need for antibacterial therapy is discussed quite controversial. In particular, in Holland doctors are very cautious on the basis of a large multicenter study of antibiotic therapy. The vast majority of international infectious Experts advise however to antibacterial therapy, which also can contribute in particular to avoid the rare but serious complications such as meningitis, mastoiditis and hearing loss. The most recommended therapy is amoxicillin (Amoxypen others). This therapy should be in the regions with higher ampicillin or Amoxicillinresistenz with Haemophilus influenzae and Moraxella catarrhalis replaced by Betalaktamasebildung however by beta-lactamase stable substances, such as Amoxicillin-clavulanate (Augmentin), ampicillin-sulbactam (UNACID), piperacillin-tazobactam (TAZOBAC), piperacillin (Pipril) plus sulbactam (COMBACTAM), cefaclor (PANORAL), cefuroxime axetil (ELOBACT, Zinnat), cefpodoxime proxetil (ORELOX , PODOMEXEF) sowieLoracarbef (LORAFEM).
Concomitant treatment with mucosa decongestant substances to keep open the Eustachian tube is recommended. Also should take place after a few weeks after expiry of otitis media, a control of the middle ear in terms of persistent liquid form.