View source for Otitis media

{{Short description|Inflammation of the middle ear}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox medical condition
| name            = Otitis media
| synonyms        = '''Otitis media with effusion''': serous otitis media, secretory otitis media
| image           = Otitis media entdifferenziert2.jpg
| caption         = A bulging [[tympanic membrane]] which is typical in a case of acute otitis media
| field           = [[Otorhinolaryngology]]
| symptoms        = Ear pain, fever, hearing loss<ref name=Peads2013/><ref name=Qu2014/>
| onset           =
| duration        =
| types           = Acute otitis media, otitis media with effusion, chronic suppurative otitis media<ref name=CDC2013Ear/><ref name=Min2014/>
| causes          = Viral, bacterial<ref name=Min2014/>
| risks           = Smoke exposure, daycare<ref name=Min2014/>
| diagnosis       =
| differential    =
| prevention      = Vaccination, breastfeeding<ref name=Peads2013/>
| treatment       =
| medication      = [[Paracetamol]] (acetaminophen), [[ibuprofen]], [[benzocaine]] ear drops<ref name=Peads2013/>
| frequency       = 471 million (2015)<ref name=GBD2015Pre>{{cite journal | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, etal | collaboration = GBD 2015 Disease and Injury Incidence and Prevalence Collaborators | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 }}</ref>
| deaths          = 3,200 (2015)<ref name=GBD2015De/>
}}

'''Otitis media''' is a group of [[Inflammation|inflammatory]] diseases of the [[middle ear]].<ref name=Qu2014/> One of the two main types is '''acute otitis media''' ('''AOM'''),<ref name=CDC2013Ear/> an [[infection]] of rapid onset that usually presents with ear pain.<ref name=Peads2013/> In young children, this may result in pulling at the ear, increased crying, and poor sleep.<ref name=Peads2013/> Decreased eating and a [[fever]] may also be present.<ref name=Peads2013/> 

The other main type is '''otitis media with effusion''' ('''OME'''), typically not associated with symptoms,<ref name=Peads2013/> although occasionally a feeling of fullness is described;<ref name=Min2014/> it is defined as the presence of non-infectious fluid in the middle ear which may persist for weeks or months often after an episode of acute otitis media.<ref name=Min2014/> '''Chronic suppurative otitis media''' ('''CSOM''') is middle ear inflammation that results in a perforated tympanic membrane with discharge from the ear for more than six weeks.<ref name=Em2-18>{{cite journal | vauthors = Emmett SD, Kokesh J, Kaylie D | title = Chronic Ear Disease | journal = The Medical Clinics of North America | volume = 102 | issue = 6 | pages = 1063–1079 | date = November 2018 | pmid = 30342609 | doi = 10.1016/j.mcna.2018.06.008 | s2cid = 53045631 }}</ref> It may be a complication of acute otitis media.<ref name=Min2014/> Pain is rarely present.<ref name=Min2014/> 

All three types of otitis media may be associated with [[hearing loss]].<ref name=Qu2014>{{cite journal | vauthors = Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M | title = Update on otitis media – prevention and treatment | journal = Infection and Drug Resistance | volume = 7 | pages = 15–24 | date = January 2014 | pmid = 24453496 | pmc = 3894142 | doi = 10.2147/IDR.S39637 | doi-access = free }}</ref><ref name=CDC2013Ear/> If children with hearing loss due to OME do not learn [[sign language]], it may affect their ability to learn.<ref>{{Cite journal|last1=Ruben|first1=Robert J|last2=Schwartz|first2=Richard|date=February 1999|title=Necessity versus sufficiency: the role of input in language acquisition|url=https://linkinghub.elsevier.com/retrieve/pii/S0165587698001323|journal=International Journal of Pediatric Otorhinolaryngology|language=en|volume=47|issue=2|pages=137–140|doi=10.1016/S0165-5876(98)00132-3|pmid=10206361|access-date=2021-09-27|archive-date=2018-06-14|archive-url=https://web.archive.org/web/20180614035536/https://linkinghub.elsevier.com/retrieve/pii/S0165587698001323|url-status=live|url-access=subscription}}</ref>

The cause of AOM is related to childhood [[anatomy]] and [[immune system|immune function]].<ref name="Min2014" /> Either bacteria or viruses may be involved.<ref name="Min2014" /> Risk factors include exposure to smoke, use of [[pacifiers]], and attending [[Child care|daycare]].<ref name="Min2014" /> It occurs more commonly among [[indigenous Australians]] and those who have [[cleft lip and palate]] or [[Down syndrome]].<ref name="Min2014">{{cite journal | vauthors = Minovi A, Dazert S | title = Diseases of the middle ear in childhood | journal = GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery | volume = 13 | pages = Doc11 | date = 2014 | pmid = 25587371 | pmc = 4273172 | doi = 10.3205/cto000114 }}</ref><ref>{{cite web|title=Ear disease in Aboriginal and Torres Strait Islander children|url=http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Our_publications/2014/ctgc-rs35.pdf|website=AIHW|access-date=12 May 2017|archive-url=https://web.archive.org/web/20170217221423/http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Our_publications/2014/ctgc-rs35.pdf|archive-date=17 February 2017}}</ref> OME frequently occurs following AOM and may be related to [[viral upper respiratory infection]]s, irritants such as smoke, or [[allergies]].<ref name="CDC2013Ear">{{cite web|title=Ear Infections|url=https://www.cdc.gov/getsmart/antibiotic-use/URI/ear-infection.html|website=cdc.gov|access-date=14 February 2015|date=September 30, 2013|url-status=live|archive-url=https://web.archive.org/web/20150219034155/http://www.cdc.gov/getsmart/antibiotic-use/uri/ear-infection.html|archive-date=19 February 2015}}</ref><ref name="Min2014" /> Looking at the eardrum is important for making the correct diagnosis.<ref name="Coker2010">{{cite journal | vauthors = Coker TR, Chan LS, Newberry SJ, Limbos MA, Suttorp MJ, Shekelle PG, Takata GS | title = Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review | journal = JAMA | volume = 304 | issue = 19 | pages = 2161–2169 | date = November 2010 | pmid = 21081729 | doi = 10.1001/jama.2010.1651 | doi-access = free }}</ref> Signs of AOM include bulging or a lack of movement of the [[tympanic membrane]] from a puff of air.<ref name="Peads2013">{{cite journal | vauthors = Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, Joffe MD, Miller DT, Rosenfeld RM, Sevilla XD, Schwartz RH, Thomas PA, Tunkel DE | title = The diagnosis and management of acute otitis media | journal = Pediatrics | volume = 131 | issue = 3 | pages = e964–999 | date = March 2013 | pmid = 23439909 | doi = 10.1542/peds.2012-3488 | doi-access = free }}</ref><ref name="CDC2013A">{{cite web|title=Otitis Media: Physician Information Sheet (Pediatrics)|url=https://www.cdc.gov/getsmart/community/materials-references/print-materials/hcp/child-otitismedia.html|website=cdc.gov|access-date=14 February 2015|date=November 4, 2013|url-status=live|archive-url=https://web.archive.org/web/20150910172946/http://www.cdc.gov/getsmart/community/materials-references/print-materials/hcp/child-otitismedia.html|archive-date=10 September 2015}}</ref> New discharge not related to [[otitis externa]] also indicates the diagnosis.<ref name="Peads2013" />

A number of measures decrease the risk of otitis media including [[pneumococcal vaccine|pneumococcal]] and [[influenza vaccine|influenza vaccination]], [[breastfeeding]], and avoiding tobacco smoke.<ref name=Peads2013/> The use of [[analgesic|pain medications]] for AOM is important.<ref name=Peads2013/> This may include [[paracetamol]] (acetaminophen), [[ibuprofen]], [[benzocaine]] ear drops, or [[opioids]].<ref name=Peads2013/> In AOM, antibiotics may speed recovery but may result in side effects.<ref name=":3">{{Cite journal |last1=Venekamp |first1=Roderick P. |last2=Sanders |first2=Sharon L. |last3=Glasziou |first3=Paul P. |last4=Rovers |first4=Maroeska M. |date=2023-11-15 |title=Antibiotics for acute otitis media in children |journal=The Cochrane Database of Systematic Reviews |volume=11 |issue=11 |article-number=CD000219 |doi=10.1002/14651858.CD000219.pub5 |issn=1469-493X |pmc=10646935 |pmid=37965923}}</ref> Antibiotics are often recommended in those with severe disease or under two years old.<ref name=CDC2013A/> In those with less severe disease they may only be recommended in those who do not improve after two or three days.<ref name=CDC2013A/> The initial antibiotic of choice is typically [[amoxicillin]].<ref name=Peads2013/> In those with frequent infections, surgical placement of [[tympanostomy tubes]] may decrease recurrence.<ref name=Peads2013/> In children with otitis media with effusion [[antibiotics]] may increase resolution of symptoms, but may cause diarrhoea, vomiting and skin rash.<ref>{{cite journal | vauthors = Venekamp RP, Burton MJ, van Dongen TM, van der Heijden GJ, van Zon A, Schilder AG | title = Antibiotics for otitis media with effusion in children | journal = The Cochrane Database of Systematic Reviews | issue = 6 | article-number = CD009163 | date = June 2016 | volume = 2016 | pmid = 27290722 | doi = 10.1002/14651858.CD009163.pub3 | pmc = 7117560 }}</ref>

Worldwide, AOM affects about 11% of people a year (about 710&nbsp;million cases).<ref name=Mon2012/><ref name = "GBDS_2013">{{cite journal | vauthors = Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, etal | collaboration = Global Burden of Disease Study 2013 Collaborators | title = Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 386 | issue = 9995 | pages = 743–800 | date = August 2015 | pmid = 26063472 | pmc = 4561509 | doi = 10.1016/s0140-6736(15)60692-4 }}</ref> Half the cases involve children less than five years of age and it is more common among males.<ref name=Min2014/><ref name=Mon2012/> Of those affected about 4.8% or 31&nbsp;million develop chronic suppurative otitis media (CSOM).<ref name=Mon2012>{{cite journal | vauthors = Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, Grasso D, Barbiero C, Tamburlini G | title = Burden of disease caused by otitis media: systematic review and global estimates | journal = PLOS ONE | volume = 7 | issue = 4 | article-number = e36226 | date = 2012 | pmid = 22558393 | pmc = 3340347 | doi = 10.1371/journal.pone.0036226 | bibcode = 2012PLoSO...736226M | doi-access = free }}</ref> The total number of people with CSOM is estimated at 65–330 million people.<ref>{{Cite journal|last=Erasmus|first=Theresa|date=2012-09-17|title=Chronic suppurative otitis media|url=http://www.cmej.org.za/index.php/cmej/article/view/2464|journal=Continuing Medical Education|volume=30|issue=9|pages=335–336–336|issn=2078-5143|access-date=2019-08-07|archive-date=2020-10-20|archive-url=https://web.archive.org/web/20201020134627/http://www.cmej.org.za/index.php/cmej/article/view/2464|url-status=live}}</ref> Before the age of ten, OME affects about 80% of children at some point.<ref name=Min2014/> Otitis media resulted in 3,200 deaths in 2015 – down from 4,900 deaths in 1990.<ref name=GBD2015De>{{cite journal | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal | collaboration = GBD 2015 Mortality and Causes of Death Collaborators | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 }}</ref><ref name=GBD204>{{cite journal | title = Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 385 | issue = 9963 | pages = 117–171 | date = January 2015 | pmid = 25530442 | pmc = 4340604 | doi = 10.1016/S0140-6736(14)61682-2 | author1 = GBD 2013 Mortality and Causes of Death Collaborators }}</ref>

== Signs and symptoms ==
[[File:Otitis Media.png|thumb|upright=1.3|Otitis media]]
The primary symptom of acute otitis media is [[otalgia|ear pain]]; other possible symptoms include [[fever]], reduced hearing during periods of illness, tenderness on touch of the skin above the ear, purulent discharge from the ears, [[irritability]], ear blocking sensation and diarrhea (in infants). Since an episode of otitis media is usually precipitated by an [[upper respiratory tract infection]] (URTI), there are often accompanying symptoms like a [[cough]] and [[nasal discharge]].<ref name="Peads2013"/> One might also experience a feeling of fullness in the ear.

Discharge from the ear can be caused by acute otitis media with perforation of the eardrum, chronic suppurative otitis media, tympanostomy tube otorrhea, or acute otitis externa. Trauma, such as a [[basilar skull fracture]], can also lead to cerebrospinal fluid otorrhea (discharge of CSF from the ear) due to cerebral spinal drainage from the brain and its covering (meninges).{{citation needed|date=June 2020}}

==Causes==
The common cause of all forms of otitis media is dysfunction of the [[Eustachian tube]].<ref>{{cite book | vauthors = Bluestone CD |title= Eustachian tube: structure, function, role in otitis media |year=2005 |location=Hamilton, London |publisher=BC Decker |pages=1–219 |isbn=978-1-55009-066-6 }}</ref> This is usually due to inflammation of the [[mucous membranes]] in the [[nasopharynx]], which can be caused by a viral [[upper respiratory tract infection]] (URTI), [[strep throat]], or possibly by [[allergy|allergies]].<ref name="John D Donaldson">{{cite web |url=http://emedicine.medscape.com/article/859316-overview |title=Acute Otitis Media |first = John D | last = Donaldson |publisher=Medscape |access-date=17 March 2013 |url-status=live |archive-url=https://web.archive.org/web/20130328051741/http://emedicine.medscape.com/article/859316-overview |archive-date=28 March 2013 }}</ref>

By reflux or aspiration of unwanted secretions from the nasopharynx into the normally sterile middle-ear space, the fluid may then become infected – usually with [[bacteria]]. The virus that caused the initial upper respiratory infection can itself be identified as the [[pathogen]] causing the infection.<ref name="John D Donaldson"/>

==Diagnosis==
[[File:Subtotal Perforation of the right tympanic membrane.tif|thumbnail|290px|Perforation of the right tympanic membrane resulting from previous severe acute otitis media]]
As its typical symptoms overlap with those of other conditions, such as acute external otitis, symptoms alone are insufficient to predict whether acute otitis media is present; they must be complemented by visualization of the [[tympanic membrane]].<ref>{{cite journal | vauthors = Laine MK, Tähtinen PA, Ruuskanen O, Huovinen P, Ruohola A | title = Symptoms or symptom-based scores cannot predict acute otitis media at otitis-prone age | journal = Pediatrics | volume = 125 | issue = 5 | pages = e1154–61 | date = May 2010 | pmid = 20368317 | doi = 10.1542/peds.2009-2689 | s2cid = 709374 }}</ref><ref>{{cite journal | vauthors = Shaikh N, Hoberman A, Kaleida PH, Ploof DL, Paradise JL | title = Videos in clinical medicine. Diagnosing otitis media – otoscopy and cerumen removal | journal = The New England Journal of Medicine | volume = 362 | issue = 20 | page = e62 | date = May 2010 | pmid = 20484393 | doi = 10.1056/NEJMvcm0904397 }}</ref> Examiners may use a pneumatic [[otoscope]] with a rubber bulb attached to assess the mobility of the tympanic membrane. Other methods to diagnose otitis media are with a [[tympanometry]], [[reflectometry]], or a hearing test.

In more severe cases, such as those with associated hearing loss or high [[fever]], [[audiometry]], [[tympanogram]], [[temporal bone]] [[CT scan|CT]] and [[magnetic resonance imaging|MRI]] can be used to assess for associated complications, such as [[mastoid effusion]], [[Periosteum|subperiosteal]] [[abscess]] formation, [[osteomyelitis|bony destruction]], [[venous thrombosis]] or [[meningitis]].<ref>{{cite journal | vauthors = Patel MM, Eisenberg L, Witsell D, Schulz KA | title = Assessment of acute otitis externa and otitis media with effusion performance measures in otolaryngology practices | journal =  Otolaryngology–Head and Neck Surgery | volume = 139 | issue = 4 | pages = 490–494 | date = October 2008 | pmid = 18922333 | doi = 10.1016/j.otohns.2008.07.030 | s2cid = 24036039 }}</ref> 

Acute otitis media in children with moderate to severe bulging of the tympanic membrane or new onset of otorrhea (drainage) is not due to external otitis. Also, the diagnosis may be made in children who have mild bulging of the eardrum and a recent onset of ear pain (less than 48 hours) or intense erythema (redness) of the eardrum. To confirm the diagnosis, middle-ear effusion and inflammation of the eardrum (called {{vanchor|myringitis}} or tympanitis) have to be identified; signs of these are fullness, bulging, cloudiness and redness of the eardrum.<ref name="Peads2013" /> It is important to attempt to differentiate between acute otitis media and otitis media with effusion (OME), as antibiotics are not recommended for OME.<ref name="Peads2013" /> It has been suggested that bulging of the tympanic membrane is the best sign to differentiate AOM from OME, with a bulging of the membrane suggesting AOM rather than OME.<ref name="Acad Pediatr 2012">{{cite journal | vauthors = Shaikh N, Hoberman A, Rockette HE, Kurs-Lasky M | title = Development of an algorithm for the diagnosis of otitis media | journal = Academic Pediatrics | volume = 12 | issue = 3 | pages = 214–218 | date = March 28, 2012 | pmid = 22459064 | doi = 10.1016/j.acap.2012.01.007 | url = http://d-scholarship.pitt.edu/14061/1/22459064.full.pdf | type = Submitted manuscript | access-date = November 3, 2018 | archive-date = October 26, 2020 | archive-url = https://web.archive.org/web/20201026011859/http://d-scholarship.pitt.edu/14061/1/22459064.full.pdf | url-status = live }}</ref>

Viral otitis may result in blisters on the external side of the tympanic membrane, which is called ''[[bullous myringitis]]'' (''myringa'' being Latin for "eardrum").<ref name="bm">{{cite journal | vauthors = Roberts DB | title = The etiology of bullous myringitis and the role of mycoplasmas in ear disease: a review | journal = Pediatrics | volume = 65 | issue = 4 | pages = 761–766 | date = April 1980 | doi = 10.1542/peds.65.4.761 | pmid = 7367083 | s2cid = 31536385 }}</ref> However, sometimes even examination of the eardrum may not be able to confirm the diagnosis, especially if the canal is small. If wax in the ear canal obscures a clear view of the eardrum, it should be removed using a blunt cerumen curette or a wire loop. An upset young child's crying can cause the eardrum to look inflamed due to distension of the small blood vessels on it, mimicking the redness associated with otitis media.<ref>{{Cite journal |last=Isaacson |first=Glenn |date=2016 |title=Acute Otitis Media and the Crying Child |journal=The Pediatric Infectious Disease Journal |volume=35 |issue=12 |pages=e399–e400 |doi=10.1097/INF.0000000000001335 |issn=1532-0987 |pmid=27626918}}</ref>

===Acute otitis media===
The most common bacteria isolated from the middle ear in AOM are ''[[Streptococcus pneumoniae]], [[Haemophilus influenzae]]'', ''[[Moraxella catarrhalis]],''<ref name="Peads2013"/> and ''[[Staphylococcus aureus]]''.<ref>{{cite journal | vauthors = Benninger MS | title = Acute bacterial rhinosinusitis and otitis media: changes in pathogenicity following widespread use of pneumococcal conjugate vaccine | journal =   Otolaryngology–Head and Neck Surgery | volume = 138 | issue = 3 | pages = 274–278 | date = March 2008 | pmid = 18312870 | doi = 10.1016/j.otohns.2007.11.011 | s2cid = 207300175 }}</ref> Worldwide, approximately 11% of the human population is affected by AOM every year, or 709 million cases.<ref name=Mon2012 />

===Otitis media with effusion===
Otitis media with [[effusion]] (OME), also known as serous otitis media (SOM) or secretory otitis media (SOM), and colloquially referred to as 'glue ear',<ref>{{cite web |url=http://www.nhs.uk/conditions/Glue-ear/Pages/Introduction.aspx |title=Glue Ear |work=NHS Choices |publisher=Department of Health |access-date=3 November 2012 |url-status=live |archive-url=https://web.archive.org/web/20121113094501/http://www.nhs.uk/conditions/Glue-ear/Pages/Introduction.aspx |archive-date=13 November 2012 }}</ref> is fluid accumulation that can occur in the [[middle ear]] and [[mastoid air cells]] due to negative pressure produced by dysfunction of the Eustachian tube. This can be associated with a viral upper respiratory infection (URI) or bacterial infection such as otitis media.<ref name="Rosenfeld RM, Culpepper L, Yawn B, Mahoney MC 2776, 2778–9">{{cite journal | vauthors = Rosenfeld RM, Culpepper L, Yawn B, Mahoney MC | title = Otitis media with effusion clinical practice guideline | journal = American Family Physician | volume = 69 | issue = 12 | pages = 2776, 2778–2779 | date = June 2004 | pmid = 15222643 }}</ref> An effusion can cause [[conductive hearing loss]] if it interferes with the transmission of vibrations of [[ossicles|middle ear bones]] to the [[vestibulocochlear nerve|vestibulocochlear nerve complex]] that are created by [[sound wave]]s.<ref>{{cite web |url=https://medlineplus.gov/ency/article/007010.htm |title=Otitis media with effusion: MedlinePlus Medical Encyclopedia |publisher=U.S. National Library of Medicine |access-date=17 February 2017 |url-status=live |archive-url=https://web.archive.org/web/20170217223551/https://medlineplus.gov/ency/article/007010.htm |archive-date=17 February 2017 }}</ref>

Early-onset OME is associated with feeding of infants while lying down, early entry into group [[child care]], parental [[smoking]], lack or too short a period of [[breastfeeding]], and greater amounts of time spent in group child care, particularly those with a large number of children. These risk factors increase the incidence and duration of OME during the first two years of life.<ref>{{cite journal | vauthors = Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM | title = Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life | journal = The Journal of Pediatrics | volume = 123 | issue = 5 | pages = 702–711 | date = November 1993 | pmid = 8229477 | doi = 10.1016/S0022-3476(05)80843-1 }}</ref>

===Chronic suppurative otitis media===
Chronic suppurative otitis media (CSOM) is a long-term middle ear inflammation causing persistent ear discharge due to a [[perforated eardrum]].<ref name=Mon2012 /> It often follows an unresolved upper respiratory infection leading to acute otitis media. Prolonged inflammation leads to middle ear swelling, ulceration, perforation, and attempts at repair with granulation tissue and polyps. This can worsen discharge and inflammation, potentially developing into CSOM, often associated with cholesteatoma. Symptoms may include ear discharge or pus seen only on examination. Hearing loss is common. Risk factors include poor eustachian tube function, recurrent ear infections, crowded living, daycare attendance, and certain craniofacial malformations.{{citation needed|date=June 2020}}

According to the [[World Health Organization]], CSOM is a primary cause of hearing loss in children.<ref name=acuin /> Adults with recurrent episodes of CSOM have a higher risk of developing permanent conductive and sensorineural hearing loss.

About 0.5% of the population develop CSOM each year.<ref name=Mon2012 /> In Britain, 0.9% of children and 0.5% of adults have CSOM, with no difference between the sexes.<ref name=acuin/> The incidence of CSOM worldwide varies dramatically, where high-income countries having a relatively low prevalence, while in low-income countries the prevalence may be up to three times as great.<ref name=Mon2012 /> Each year, 21,000 people worldwide die due to complications of CSOM.<ref name=acuin>{{cite book |title=Chronic suppurative otitis media: burden of illness and management options | vauthors = Acuin J, ((WHO Dept. of Child and Adolescent Health and Development)), ((WHO Programme for the Prevention of Blindness and Deafness)) |location=Geneve |publisher=World Health Organization |isbn=978-92-4-159158-4 |year=2004 |hdl=10665/42941 }}</ref>

===Adhesive otitis media===
Adhesive otitis media occurs when a thin [[tympanic membrane retraction|retracted eardrum]] becomes sucked into the middle-ear space and stuck (i.e., adherent) to the [[ossicle]]s and other bones of the middle ear.

==Prevention==

AOM is far less common in breastfed infants than in formula-fed infants,<ref name=Lawrence2016/> and the greatest protection is associated with exclusive breastfeeding (no formula use) for the first six months of life.<ref name=Peads2013/> A longer duration of breastfeeding is correlated with a longer protective effect.<ref name=Lawrence2016>{{cite book | last=Lawrence | first=Ruth | title=Breastfeeding: a guide for the medical profession, 8th edition | publisher=Elsevier | location=Philadelphia, PA | year=2016 | isbn=978-0-323-35776-0 | pages = 216–217}}</ref>

[[Pneumococcal conjugate vaccine]]s (PCV) in early infancy decrease the risk of acute otitis media in healthy infants.<ref name=":2">{{Cite journal|last1=Fortanier|first1=Alexandre C.|last2=Venekamp|first2=Roderick P.|last3=Boonacker|first3=Chantal Wb|last4=Hak|first4=Eelko|last5=Schilder|first5=Anne Gm|last6=Sanders|first6=Elisabeth Am|last7=Damoiseaux|first7=Roger Amj|date=28 May 2019|title=Pneumococcal conjugate vaccines for preventing acute otitis media in children|journal=The Cochrane Database of Systematic Reviews|volume=5|issue=5 |article-number=CD001480|doi=10.1002/14651858.CD001480.pub5|issn=1469-493X|pmc=6537667|pmid=31135969}}</ref> PCV is recommended for all children, and, if implemented broadly, PCV would have a significant [[public health]] benefit.<ref name="Peads2013"/> [[Influenza vaccine|Influenza vaccination]] in children appears to reduce rates of AOM by 4% and the use of antibiotics by 11% over 6 months.<ref name=Nor2017/> However, the vaccine resulted in increased adverse effects such as fever and runny nose.<ref name=Nor2017/> The small reduction in AOM may not justify the side effects and inconvenience of influenza vaccination every year for this purpose alone.<ref name=Nor2017>{{cite journal | vauthors = Norhayati MN, Ho JJ, Azman MY | title = Influenza vaccines for preventing acute otitis media in infants and children | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | article-number = CD010089 | date = October 2017 | issue = 10 | pmid = 29039160 | pmc = 6485791 | doi = 10.1002/14651858.CD010089.pub3 }}</ref> PCV does not appear to decrease the risk of otitis media when given to high-risk infants or for older children who have previously experienced otitis media.<ref name=":2" />

Risk factors such as season, allergy predisposition and presence of older siblings are known to be determinants of recurrent otitis media and persistent middle-ear effusions (MEE).<ref>{{cite journal | vauthors = Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM | title = Otitis media | journal = Lancet | volume = 363 | issue = 9407 | pages = 465–473 | date = February 2004 | pmid = 14962529 | doi = 10.1016/S0140-6736(04)15495-0 | s2cid = 30439271 }}</ref> History of recurrence, environmental exposure to tobacco smoke, use of daycare, and lack of breastfeeding have all been associated with increased risk of development, recurrence, and persistent MEE.<ref name="Pukander J, Luotonem J, Timonen M, Karma P 1985 260–265">{{cite journal | vauthors = Pukander J, Luotonen J, Timonen M, Karma P | title = Risk factors affecting the occurrence of acute otitis media among 2–3-year-old urban children | journal = Acta Oto-Laryngologica | volume = 100 | issue = 3–4 | pages = 260–265 | year = 1985 | pmid = 4061076 | doi = 10.3109/00016488509104788 }}</ref><ref name="Etzel RA 1987 309–311">{{cite journal | vauthors = Etzel RA | title = Smoke and ear effusions | journal = Pediatrics | volume = 79 | issue = 2 | pages = 309–311 | date = February 1987 | doi = 10.1542/peds.79.2.309a | pmid = 3808812 | s2cid = 1350590 }}</ref> Pacifier use has been associated with more frequent episodes of AOM.<ref>{{cite journal | vauthors = Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG | title = Is pacifier use a risk factor for acute otitis media? A dynamic cohort study | journal = Family Practice | volume = 25 | issue = 4 | pages = 233–236 | date = August 2008 | pmid = 18562333 | doi = 10.1093/fampra/cmn030 | doi-access = free }}</ref>

Long-term antibiotics, while they decrease rates of infection during treatment, have an unknown effect on long-term outcomes such as [[hearing loss]].<ref>{{cite journal | vauthors = Leach AJ, Morris PS | title = Antibiotics for the prevention of acute and chronic suppurative otitis media in children | journal = The Cochrane Database of Systematic Reviews | issue = 4 | article-number = CD004401 | date = October 2006 | volume = 2013 | pmid = 17054203 | doi = 10.1002/14651858.CD004401.pub2 | veditors = Leach AJ | pmc = 11324013 }}</ref> This method of prevention has been associated with the emergence of undesirable [[Antibiotic-resistant bacteria|antibiotic-resistant otitic bacteria]].<ref name="Peads2013"/>

There is moderate evidence that the sugar substitute [[xylitol]] may reduce infection rates in healthy children who go to daycare.<ref>{{cite journal | vauthors = Azarpazhooh A, Lawrence HP, Shah PS | title = Xylitol for preventing acute otitis media in children up to 12 years of age | journal = The Cochrane Database of Systematic Reviews | issue = 8 | article-number = CD007095 | date = August 2016 | volume = 2016 | pmid = 27486835 | doi = 10.1002/14651858.CD007095.pub3 | pmc = 8485974 }} {{open access}}</ref>

Evidence does not support [[zinc]] supplementation as an effort to reduce otitis rates except maybe in those with severe [[malnutrition]] such as [[marasmus]].<ref>{{cite journal | vauthors = Gulani A, Sachdev HS | title = Zinc supplements for preventing otitis media | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 6 | article-number = CD006639 | date = June 2014 | pmid = 24974096 | doi = 10.1002/14651858.CD006639.pub4 | pmc = 9392835 }}</ref>

[[Probiotic]]s do not show evidence of preventing acute otitis media in children.<ref>{{cite journal |last1=Scott |first1=Anna M |last2=Clark |first2=Justin |last3=Julien |first3=Blair |last4=Islam |first4=Farhana |last5=Roos |first5=Kristian |last6=Grimwood |first6=Keith |last7=Little |first7=Paul |last8=Del Mar |first8=Chris B |title=Probiotics for preventing acute otitis media in children |journal=Cochrane Database of Systematic Reviews |date=18 June 2019 |volume=2019 |issue=6 |article-number=CD012941 |doi=10.1002/14651858.CD012941.pub2|pmid=31210358 |pmc=6580359 }}</ref>

==Management==
Oral and topical [[analgesics|pain killers]] are the mainstay for the treatment of pain caused by otitis media. Oral agents include [[ibuprofen]], [[paracetamol]] (acetaminophen), and [[opiates]]. A 2023 review found evidence for the effectiveness of single or combinations of oral pain relief in acute otitis media is limited.<ref>{{cite journal |last1=de Sévaux |first1=JLH |last2=Damoiseaux |first2=RA |last3=van de Pol |first3=AC |last4=Lutje |first4=V |last5=Hay |first5=AD |last6=Little |first6=P |last7=Schilder |first7=AG |last8=Venekamp |first8=RP |title=Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children. |journal=The Cochrane Database of Systematic Reviews |date=18 August 2023 |volume=2023 |issue=8 |article-number=CD011534 |doi=10.1002/14651858.CD011534.pub3 |pmid=37594020 |pmc=10436353 }}</ref> Topical agents shown to be effective include [[antipyrine and benzocaine ear drops]].<ref>{{cite journal | title = Best evidence topic reports. Bet 1. The role of topical analgesia in acute otitis media | journal = Emergency Medicine Journal | volume = 25 | issue = 2 | pages = 103–4 | date = February 2008 | pmid = 18212148 | doi = 10.1136/emj.2007.056648 | author = Sattout A | s2cid = 34753900 }}</ref> 

A 2008 review found reason to not recommend [[decongestants]] and [[antihistamine]]s, either nasal or oral, due to the lack of benefit and concerns regarding side effects, but this review was withdrawn from publication for being outdated.<ref>{{cite journal | vauthors = Coleman C, Moore M | title = Decongestants and antihistamines for acute otitis media in children | journal = The Cochrane Database of Systematic Reviews | issue = 3 | article-number = CD001727 | date = July 2008 | pmid = 18646076 | doi = 10.1002/14651858.CD001727.pub4 | veditors = Coleman C }} {{Retracted|doi=10.1002/14651858.CD001727.pub5|pmid=21412874|https://retractionwatch.com/2010/09/20/progressive-how-the-cochrane-library-handles-updates-in-progress/ ''Retraction Watch''|intentional=yes}}</ref> Half of cases of [[ear pain]] in children resolve without treatment in three days and 90% resolve in seven or eight days.<ref>{{cite journal | vauthors = Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD | title = Duration of symptoms of respiratory tract infections in children: systematic review | journal = BMJ | volume = 347 | article-number = f7027 | date = December 2013 | issue = dec11 1 | pmid = 24335668 | pmc = 3898587 | doi = 10.1136/bmj.f7027 }}</ref> The use of steroids is not supported by the evidence for acute otitis media.<ref>{{cite journal | vauthors = Principi N, Bianchini S, Baggi E, Esposito S | title = No evidence for the effectiveness of systemic corticosteroids in acute pharyngitis, community-acquired pneumonia and acute otitis media | journal = European Journal of Clinical Microbiology & Infectious Diseases | volume = 32 | issue = 2 | pages = 151–60 | date = February 2013 | pmid = 22993127 | doi = 10.1007/s10096-012-1747-y | pmc = 7087613 }}</ref><ref>{{cite journal | vauthors = Ranakusuma RW, Pitoyo Y, Safitri ED, Thorning S, Beller EM, Sastroasmoro S, Del Mar CB | title = Systemic corticosteroids for acute otitis media in children | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | article-number = CD012289 | date = March 2018 | issue = 3 | pmid = 29543327 | pmc = 6492450 | doi = 10.1002/14651858.CD012289.pub2 | url = https://pure.bond.edu.au/ws/files/32880265/Systemic_corticosteroids_for_acute_otitis_media_in_children.pdf | access-date = 2019-12-16 | archive-date = 2020-10-30 | archive-url = https://web.archive.org/web/20201030093544/https://pure.bond.edu.au/ws/files/32880265/Systemic_corticosteroids_for_acute_otitis_media_in_children.pdf | url-status = live }}</ref>

===Antibiotics===

Use of antibiotics for acute otitis media has benefits and harms. As over 82% of acute episodes settle without treatment, about 20 children must be treated to prevent one case of ear pain, 33 children to prevent one [[perforation]], and 11 children to prevent one opposite-side ear infection. For every 14 children treated with antibiotics, one child has an episode of vomiting, diarrhea or a rash.<ref>{{Cite journal |last1=Venekamp |first1=Roderick P. |last2=Sanders |first2=Sharon L. |last3=Glasziou |first3=Paul P. |last4=Rovers |first4=Maroeska M. |date=2023-11-15 |title=Antibiotics for acute otitis media in children |journal=The Cochrane Database of Systematic Reviews |volume=11 |issue=11 |article-number=CD000219 |doi=10.1002/14651858.CD000219.pub5 |issn=1469-493X |pmc=10646935 |pmid=37965923}}</ref> [[Analgesic]]s may relieve pain, if present. For people requiring surgery to treat otitis media with effusion, preventive antibiotics may not help reduce the risk of post-surgical complications.<ref>{{cite journal | vauthors = Verschuur HP, de Wever WW, van Benthem PP | title = Antibiotic prophylaxis in clean and clean-contaminated ear surgery | journal = The Cochrane Database of Systematic Reviews | issue = 3 | article-number = CD003996 | date = 2004 | volume = 2010 | pmid = 15266512 | doi = 10.1002/14651858.CD003996.pub2 | pmc = 9037065 }}</ref>

For bilateral acute otitis media in infants younger than 24 months, there is evidence that the benefits of antibiotics outweigh the harms.<ref name=":3" /> A 2015 Cochrane review concluded that watchful waiting is the preferred approach for children over six months with non-severe acute otitis media.<ref name=":3" />

{| class="wikitable collapsible collapsed" style="width:100%;"
! Summary<ref name=":3" />
|
|-
! scope="col" style="text-align: left; background: #d2e5ff;" | Outcome
! scope="col" style="text-align: left; background: #d2e5ff;" | Findings in words
! scope="col" style="text-align: left; background: #d2e5ff;" | Findings in numbers
! scope="col" style="text-align: left; background: #d2e5ff;" | Quality of evidence
|-
! colspan="4" style="text-align: left; background: #e3efff;" | Pain
|-
| Pain at 24 hours || Antibiotics cause little or no reduction in the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high-quality evidence.
 || [[Relative risk|RR]] 0.89 (0.78 to 1.01) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|High]]
|-
|-
| Pain at 2 to 3 days || Antibiotics slightly reduce the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high-′quality evidence.
 || [[Relative risk|RR]] 0.70 (0.57 to 0.86) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|High]]
|-
| Pain at 4 to 7 days || Antibiotics slightly reduce the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high-quality evidence.
 || [[Relative risk|RR]] 0.76 (0.63 to 0.91) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|High]]
|-
| Pain at 10 to 12 days || Antibiotics probably reduce the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on moderate-quality evidence.
 || [[Relative risk|RR]] 0.33 (0.17 to 0.66) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|Moderate]]
|-
! colspan="4" style="text-align: left; background: #e3efff;" | Abnormal tympanometry
|-
| 2 to 4 weeks || Antibiotics slightly reduce the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high-quality evidence.
 || [[Relative risk|RR]] 0.82 (0.74 to 0.90) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|High]]
|-
| 3 months || Antibiotics cause little or no reduction in the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high-quality evidence.
 || [[Relative risk|RR]] 0.97 (0.76 to 1.24) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|High]]
|-
! colspan="4" style="text-align: left; background: #e3efff;" | Vomiting
|-
| Diarrhoea or rash || Antibiotics slightly increase the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high-quality evidence.
 || [[Relative risk|RR]] 1.38 (1.19 to 1.59) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|High]]
|-
|}

Most children older than 6 months of age who have acute otitis media do not benefit from treatment with antibiotics. If antibiotics are used, a [[narrow-spectrum antibiotic]] like [[amoxicillin]] is generally recommended, as [[broad-spectrum antibiotics]] may be associated with more adverse events.<ref name="Peads2013"/><ref>{{cite journal | vauthors = Coon ER, Quinonez RA, Morgan DJ, Dhruva SS, Ho T, Money N, Schroeder AR | title = 2018 Update on Pediatric Medical Overuse: A Review | journal = JAMA Pediatrics | volume = 173 | issue = 4 | pages = 379–384 | date = April 2019 | pmid = 30776069 | doi = 10.1001/jamapediatrics.2018.5550 | s2cid = 73495617 }}</ref> If there is [[antibiotic resistance|resistance]] or use of amoxicillin in the last 30 days then [[co-amoxiclav|amoxicillin-clavulanate]] or another penicillin derivative plus beta lactamase inhibitor is recommended.<ref name="Peads2013"/> Taking amoxicillin once a day may be as effective as twice<ref>{{cite journal | vauthors = Thanaviratananich S, Laopaiboon M, Vatanasapt P | title = Once or twice daily versus three times daily amoxicillin with or without clavulanate for the treatment of acute otitis media | journal = The Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | article-number = CD004975 | date = December 2013 | pmid = 24338106 | doi = 10.1002/14651858.CD004975.pub3 | pmc = 10960641 }}</ref> or three times a day. While less than 7 days of antibiotics have fewer side effects, more than seven days appear to be more effective.<ref>{{cite journal | vauthors = Kozyrskyj A, Klassen TP, Moffatt M, Harvey K | title = Short-course antibiotics for acute otitis media | journal = The Cochrane Database of Systematic Reviews | issue = 9 | article-number = CD001095 | date = September 2010 | volume = 2010 | pmid = 20824827 | doi = 10.1002/14651858.CD001095.pub2 | pmc = 7052812 }}</ref> If there is no improvement after 2–3&nbsp;days of treatment, a change in therapy may be considered.<ref name="Peads2013"/> Azithromycin appears to have fewer side effects than either high-dose amoxicillin or amoxicillin/clavulanate.<ref>{{cite journal | vauthors = Hum SW, Shaikh KJ, Musa SS, Shaikh N | title = Adverse Events of Antibiotics Used to Treat Acute Otitis Media in Children: A Systematic Meta-Analysis | journal = The Journal of Pediatrics | volume = 215 | pages = 139–143.e7 | date = December 2019 | pmid = 31561959 | doi = 10.1016/j.jpeds.2019.08.043 | s2cid = 203580952 }}</ref>

===Tympanostomy tube===
[[Tympanostomy tube]]s (also called "grommets") are recommended with three or more episodes of acute otitis media in 6 months or four or more in a year, with at least one episode or more attacks in the preceding 6 months.<ref name="Peads2013"/> There is tentative evidence that children with recurrent acute otitis media (AOM) who receive tubes have a modest improvement in the number of further AOM episodes (around one fewer episode at six months and less of an improvement at 12 months following the tubes being inserted).<ref name=Venekamp2018>{{cite journal | vauthors = Venekamp RP, Mick P, Schilder AG, Nunez DA | title = Grommets (ventilation tubes) for recurrent acute otitis media in children | journal = The Cochrane Database of Systematic Reviews | volume = 5 | article-number = CD012017 | date = May 2018 | issue = 6 | pmid = 29741289 | pmc = 6494623 | doi = 10.1002/14651858.CD012017.pub2 }}</ref><ref name=St2017/> 

Evidence does not support an effect on long-term hearing or language development.<ref name=St2017>{{cite journal | vauthors = Steele DW, Adam GP, Di M, Halladay CH, Balk EM, Trikalinos TA | title = Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis | journal = Pediatrics | volume = 139 | issue = 6 | pages = e20170125 | date = June 2017 | pmid = 28562283 | doi = 10.1542/peds.2017-0125 | doi-access = free }}</ref><ref name=":0">{{cite journal | vauthors = Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ | title = Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children | journal = The Cochrane Database of Systematic Reviews | issue = 10 | article-number = CD001801 | date = October 2010 | pmid = 20927726 | doi = 10.1002/14651858.CD001801.pub3 | s2cid = 43568574 }}</ref> A common complication of having a tympanostomy tube is otorrhea, which is a discharge from the ear.<ref name="AANfive">{{Citation |author1 = American Academy of Otolaryngology–Head and Neck Surgery |author1-link = American Academy of Otolaryngology–Head and Neck Surgery |title = Five Things Physicians and Patients Should Question |publisher = [[American Academy of Otolaryngology–Head and Neck Surgery]] |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/wp-content/uploads/2015/01/Choosing-Wisely-Recommendations.pdf |access-date = August 1, 2013 |url-status = live |archive-url = https://web.archive.org/web/20150513001448/http://www.choosingwisely.org/wp-content/uploads/2015/01/Choosing-Wisely-Recommendations.pdf |archive-date = May 13, 2015 }}, which cites
* {{cite journal | vauthors = Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, Grimes AM, Hackell JM, Harrison MF, Haskell H, Haynes DS, Kim TW, Lafreniere DC, LeBlanc K, Mackey WL, Netterville JL, Pipan ME, Raol NP, Schellhase KG | title = Clinical practice guideline: Tympanostomy tubes in children | journal =   Otolaryngology–Head and Neck Surgery | volume = 149 | issue = 1 Suppl | pages = S1–35 | date = July 2013 | pmid = 23818543 | doi = 10.1177/0194599813487302 | doi-access = free }}</ref> The risk of persistent [[tympanic membrane perforation]] after children have grommets inserted may be low.<ref name=Venekamp2018 /> It is still uncertain whether or not grommets are more effective than a course of antibiotics.<ref name=Venekamp2018 />

Oral antibiotics should not be used to treat uncomplicated acute tympanostomy tube otorrhea.<ref name="AANfive" /> They are not sufficient for the bacteria that cause this condition and have side effects, including increased risk of opportunistic infection.<ref name="AANfive" /> In contrast, topical antibiotic eardrops are useful.<ref name="AANfive" />

===Otitis media with effusion===
The decision to treat is usually made after a combination of physical exam and laboratory diagnosis, with additional testing including [[audiometry]], [[tympanogram]], [[temporal bone]] [[CT scan|CT]] and [[magnetic resonance imaging|MRI]].<ref name="pmid 26832942">{{cite journal | vauthors = Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, Hoelting D, Hunter LL, Kummer AW, Payne SC, Poe DS, Veling M, Vila PM, Walsh SA, Corrigan MD | title = Clinical Practice Guideline: Otitis Media with Effusion (Update) | journal = Otolaryngology–Head and Neck Surgery | volume = 154 | issue = 1 Suppl | pages = S1–S41 | date = February 2016 | pmid = 26832942 | doi = 10.1177/0194599815623467 | s2cid = 33459167 | url = https://www.med-sovet.pro/jour/article/view/2872 | access-date = 2019-03-05 | archive-date = 2019-03-06 | archive-url = https://web.archive.org/web/20190306112834/https://www.med-sovet.pro/jour/article/view/2872 | url-status = live | doi-access = free }}</ref><ref>{{cite journal | vauthors = Wallace IF, Berkman ND, Lohr KN, Harrison MF, Kimple AJ, Steiner MJ | title = Surgical treatments for otitis media with effusion: a systematic review | journal = Pediatrics | volume = 133 | issue = 2 | pages = 296–311 | date = February 2014 | pmid = 24394689 | doi = 10.1542/peds.2013-3228 | s2cid = 2355197 }}</ref><ref>{{cite journal | vauthors = Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, Grimes AM, Hackell JM, Harrison MF, Haskell H, Haynes DS, Kim TW, Lafreniere DC, LeBlanc K, Mackey WL, Netterville JL, Pipan ME, Raol NP, Schellhase KG | title = Clinical practice guideline: Tympanostomy tubes in children | journal =   Otolaryngology–Head and Neck Surgery | volume = 149 | issue = 1 Suppl | pages = S1-35 | date = July 2013 | pmid = 23818543 | doi = 10.1177/0194599813487302 | doi-access = free }}</ref> Decongestants,<ref name="Antihistamines and">{{cite journal | vauthors = Griffin G, Flynn CA | title = Antihistamines and/or decongestants for otitis media with effusion (OME) in children | journal = The Cochrane Database of Systematic Reviews | issue = 9 | article-number = CD003423 | date = September 2011 | volume = 2011 | pmid = 21901683 | doi = 10.1002/14651858.CD003423.pub3 | pmc = 7170417 }}</ref> glucocorticoids,<ref>{{cite journal | vauthors = Simpson SA, Lewis R, van der Voort J, Butler CC | title = Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children | journal = The Cochrane Database of Systematic Reviews | issue = 5 | article-number = CD001935 | date = May 2011 | volume = 2011 | pmid = 21563132 | doi = 10.1002/14651858.CD001935.pub3 | pmc = 9829244 }}</ref> and topical antibiotics are generally not effective as treatment for non-infectious, or [[serous]], causes of mastoid effusion.<ref name="pmid 26832942"/> Moreover, it is recommended against using [[antihistamine]]s and decongestants in children with OME.<ref name="Antihistamines and"/> In less severe cases or those without significant hearing impairment, the effusion can resolve spontaneously or with more conservative measures such as [[autoinflation]].<ref>{{cite journal | vauthors = Blanshard JD, Maw AR, Bawden R | title = Conservative treatment of otitis media with effusion by autoinflation of the middle ear | journal = Clinical Otolaryngology and Allied Sciences | volume = 18 | issue = 3 | pages = 188–92 | date = June 1993 | pmid = 8365006 | doi = 10.1111/j.1365-2273.1993.tb00827.x }}</ref><ref>{{cite journal | vauthors = Perera R, Glasziou PP, Heneghan CJ, McLellan J, Williamson I | title = Autoinflation for hearing loss associated with otitis media with effusion | journal = The Cochrane Database of Systematic Reviews | issue = 5 | article-number = CD006285 | date = May 2013 | pmid = 23728660 | doi = 10.1002/14651858.CD006285.pub2 | doi-access = free | pmc = 11357689 }}</ref> In more severe cases, [[tympanostomy tube]]s can be inserted,<ref name=":0" /> possibly with [[adjuvant]] [[adenoidectomy]]<ref name="pmid 26832942"/> as it shows a significant benefit as far as the resolution of middle ear effusion in children with OME is concerned.<ref>{{cite journal | vauthors = van den Aardweg MT, Schilder AG, Herkert E, Boonacker CW, Rovers MM | title = Adenoidectomy for otitis media in children | journal = The Cochrane Database of Systematic Reviews | issue = 5 | article-number = CD007810 | date = January 2010 | pmid = 20091650 | doi = 10.1002/14651858.CD007810.pub2 }}</ref>

=== Chronic suppurative otitis media ===
Topical antibiotics are of uncertain benefit as of 2020.<ref name=":4">{{Cite journal |last1=Brennan-Jones |first1=Christopher G. |last2=Head |first2=Karen |last3=Chong |first3=Lee Yee |last4=Daw |first4=Jessica |last5=Veselinović |first5=Tamara |last6=Schilder |first6=Anne Gm |last7=Bhutta |first7=Mahmood F. |date=2025-06-09 |title=Topical antibiotics for chronic suppurative otitis media |journal=The Cochrane Database of Systematic Reviews |volume=2025 |issue=6 |article-number=CD013051 |doi=10.1002/14651858.CD013051.pub3 |issn=1469-493X |pmid=40484407}}</ref> Some evidence suggests that topical antibiotics may be useful either alone or with antibiotics by mouth.<ref name=":4" /> Antiseptics are of unclear effect.<ref>{{Cite journal |last1=Head |first1=Karen |last2=Chong |first2=Lee Yee |last3=Bhutta |first3=Mahmood F. |last4=Daw |first4=Jessica |last5=Veselinović |first5=Tamara |last6=Morris |first6=Peter S. |last7=Vijayasekaran |first7=Shyan |last8=Schilder |first8=Anne Gm |last9=Brennan-Jones |first9=Christopher G. |date=2025-06-09 |title=Topical antiseptics for chronic suppurative otitis media |journal=The Cochrane Database of Systematic Reviews |volume=2025 |issue=6 |article-number=CD013055 |doi=10.1002/14651858.CD013055.pub3 |issn=1469-493X |pmc=12146031 |pmid=40484403}}</ref> Topical antibiotics (quinolones) are probably better at resolving ear discharge than antiseptics.<ref>{{Cite journal |last1=Head |first1=Karen |last2=Chong |first2=Lee Yee |last3=Bhutta |first3=Mahmood F. |last4=Daw |first4=Jessica |last5=Veselinović |first5=Tamara |last6=Morris |first6=Peter S. |last7=Vijayasekaran |first7=Shyan |last8=Schilder |first8=Anne Gm |last9=Brennan-Jones |first9=Christopher G. |date=2025-06-09 |title=Antibiotics versus topical antiseptics for chronic suppurative otitis media |journal=The Cochrane Database of Systematic Reviews |volume=2025 |issue=6 |article-number=CD013056 |doi=10.1002/14651858.CD013056.pub3 |issn=1469-493X |pmc=12145958 |pmid=40484400}}</ref>

===Alternative medicine===
[[Complementary and alternative medicine]] is not recommended for otitis media with effusion because there is no evidence of benefit.<ref name="Rosenfeld RM, Culpepper L, Yawn B, Mahoney MC 2776, 2778–9"/> [[Homeopathy|Homeopathic]] treatments have not been proven to be effective for acute otitis media in a study with children.<ref>{{cite journal | vauthors = Jacobs J, Springer DA, Crothers D | title = Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial | journal = The Pediatric Infectious Disease Journal | volume = 20 | issue = 2 | pages = 177–183 | date = February 2001 | pmid = 11224838 | doi = 10.1097/00006454-200102000-00012 }}</ref> An [[osteopathic manipulative treatment|osteopathic manipulation technique]] called the Galbreath technique<ref>{{cite journal | vauthors = Pratt-Harrington D | title = Galbreath technique: a manipulative treatment for otitis media revisited | journal = The Journal of the American Osteopathic Association | volume = 100 | issue = 10 | pages = 635–9 | date = October 2000 | doi = 10.7556/jaoa.2000.100.10.635| doi-broken-date = 12 July 2025 | pmid = 11105452 | s2cid = 245177279 | url = https://www.degruyter.com/document/doi/10.7556/jaoa.2000.100.10.635/html | access-date = 2023-05-24 | archive-date = 2023-05-24 | archive-url = https://web.archive.org/web/20230524223837/https://www.degruyter.com/document/doi/10.7556/jaoa.2000.100.10.635/html?lang=en | url-status = live }}</ref> was evaluated in one randomized controlled clinical trial; one reviewer concluded that it was promising, but a 2010 evidence report found the evidence inconclusive.<ref>{{cite journal | vauthors = Bronfort G, Haas M, Evans R, Leininger B, Triano J | title = Effectiveness of manual therapies: the UK evidence report | journal = Chiropractic & Osteopathy | volume = 18 | issue = 1 | article-number = 3 | date = February 2010 | pmid = 20184717 | pmc = 2841070 | doi = 10.1186/1746-1340-18-3 | doi-access = free }}</ref>

==Outcomes==
[[Image:Otitis media world map - DALY - WHO2004.svg|thumb|upright=1.3|[[Disability-adjusted life year]] for otitis media per 100,000&nbsp;inhabitants in 2004.
{{Col-begin}}
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{{legend|#cb0000|> 50}}
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[[File:Otitis media world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.3|Deaths from otitis media per million persons in 2012 {{Div col|small=yes|colwidth=10em}}{{legend|#ffff20|0}}{{legend|#d85010|1}}{{legend|#d02010|2–4}}{{div col end}}]]

Complications of acute otitis media consists of perforation of the ear drum, infection of the mastoid space behind the ear ([[mastoiditis]]), and more rarely intracranial complications can occur, such as [[bacterial meningitis]], [[brain abscess]], or [[dural sinus thrombosis]].<ref>{{cite journal | vauthors = Jung TT, Alper CM, Hellstrom SO, Hunter LL, Casselbrant ML, Groth A, Kemaloglu YK, Kim SG, Lim D, Nittrouer S, Park KH, Sabo D, Spratley J | title = Panel 8: Complications and sequelae | journal =   Otolaryngology–Head and Neck Surgery | volume = 148 | issue = 4 Suppl | pages = E122–143 | date = April 2013 | pmid = 23536529 | doi = 10.1177/0194599812467425 | s2cid = 206466859 }}</ref> It is estimated that each year 21,000 people die due to complications of otitis media.<ref name=Mon2012 />

===Membrane rupture===
In severe or untreated cases, the tympanic membrane may [[tympanic membrane perforation|perforate]], allowing the [[pus]] in the middle-ear space to drain into the [[ear canal]]. If there is enough, this drainage may be obvious. Even though the perforation of the tympanic membrane suggests a highly painful and traumatic process, it is almost always associated with a dramatic relief of pressure and pain. In a simple case of acute otitis media in an otherwise healthy person, the body's defenses are likely to resolve the [[infection]] and the eardrum nearly always heals.
An option for severe acute otitis media in which analgesics are not controlling ear pain is to perform a tympanocentesis, i.e., needle aspiration through the tympanic membrane to relieve the ear pain and identify the causative organism(s).

===Hearing loss===
Children with recurrent episodes of acute otitis media and those with otitis media with effusion or chronic suppurative otitis media have higher risks of developing [[conductive hearing loss|conductive]] and [[sensorineural hearing loss]]. Globally, approximately 141&nbsp;million people have mild hearing loss due to otitis media (2.1% of the population).<ref name=LancetEpi2012/> This is more common in males (2.3%) than females (1.8%).<ref name=LancetEpi2012>{{cite journal | vauthors = Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, etal | title = Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2163–96 | date = December 2012 | pmid = 23245607 | pmc = 6350784 | doi = 10.1016/S0140-6736(12)61729-2 }}</ref>

This hearing loss is mainly due to fluid in the middle ear or rupture of the tympanic membrane. Prolonged duration of otitis media is associated with ossicular complications and, together with persistent tympanic membrane perforation, contributes to the severity of the disease and hearing loss. When a cholesteatoma or granulation tissue is present in the middle ear, the degree of hearing loss and ossicular destruction is even greater.<ref>{{cite journal | vauthors = da Costa SS, Rosito LP, Dornelles C | title = Sensorineural hearing loss in patients with chronic otitis media | journal = European Archives of Oto-Rhino-Laryngology | volume = 266 | issue = 2 | pages = 221–4 | date = February 2009 | pmid = 18629531 | doi = 10.1007/s00405-008-0739-0 | hdl = 10183/125807 | s2cid = 2932807 | hdl-access = free }}</ref>

Periods of conductive hearing loss from otitis media may have a detrimental effect on speech development in children.<ref>{{cite journal | vauthors = Roberts K | title = A preliminary account of the effect of otitis media on 15-month-olds' categorization and some implications for early language learning | journal = Journal of Speech, Language, and Hearing Research | volume = 40 | issue = 3 | pages = 508–18 | date = June 1997 | pmid = 9210110 | doi = 10.1044/jslhr.4003.508 }}</ref><ref name=":1">{{cite journal | vauthors = Simpson SA, Thomas CL, van der Linden MK, Macmillan H, van der Wouden JC, Butler C | title = Identification of children in the first four years of life for early treatment for otitis media with effusion | journal = The Cochrane Database of Systematic Reviews | issue = 1 | article-number = CD004163 | date = January 2007 | volume = 2010 | pmid = 17253499 | doi = 10.1002/14651858.CD004163.pub2 | pmc = 8765114 }}</ref><ref>{{Cite journal|last1=Macfadyen|first1=C. A.|last2=Acuin|first2=J. M.|last3=Gamble|first3=C.|date=2005-10-19|title=Topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforations|journal=The Cochrane Database of Systematic Reviews|volume=2005 |issue=4|article-number=CD004618|doi=10.1002/14651858.CD004618.pub2|issn=1469-493X|pmc=6669264|pmid=16235370}}</ref> Some studies have linked otitis media to learning problems, attention disorders, and problems with social adaptation.<ref>{{cite journal | vauthors = Bidadi S, Nejadkazem M, Naderpour M | title = The relationship between chronic otitis media-induced hearing loss and the acquisition of social skills | journal =   Otolaryngology–Head and Neck Surgery | volume = 139 | issue = 5 | pages = 665–70 | date = November 2008 | pmid = 18984261 | doi = 10.1016/j.otohns.2008.08.004 | s2cid = 37667672 }}</ref> Furthermore, it has been demonstrated that individuals with otitis media have more depression/anxiety-related disorders compared to individuals with normal hearing.<ref>{{cite journal | vauthors = Gouma P, Mallis A, Daniilidis V, Gouveris H, Armenakis N, Naxakis S | title = Behavioral trends in young children with conductive hearing loss: a case-control study | journal = European Archives of Oto-Rhino-Laryngology | volume = 268 | issue = 1 | pages = 63–6 | date = January 2011 | pmid = 20665042 | doi = 10.1007/s00405-010-1346-4 | s2cid = 24611204 }}</ref> Once the infections resolve and hearing thresholds return to normal, childhood otitis media may still cause minor and irreversible damage to the middle ear and cochlea.<ref>{{cite journal | vauthors = Yilmaz S, Karasalihoglu AR, Tas A, Yagiz R, Tas M | title = Otoacoustic emissions in young adults with a history of otitis media | journal = The Journal of Laryngology and Otology | volume = 120 | issue = 2 | pages = 103–7 | date = February 2006 | pmid = 16359151 | doi = 10.1017/S0022215105004871 | s2cid = 23668097 }}</ref> More research on the importance of screening all children under 4 years old for otitis media with effusion needs to be performed.<ref name=":1" />

==Epidemiology==
Acute otitis media is very common in childhood. It is the most common condition for which medical care is provided in children under five years of age in the US.<ref name="John D Donaldson" /> Acute otitis media affects 11% of people each year (709&nbsp;million cases) with half occurring in those below five years.<ref name=Mon2012 /> Chronic suppurative otitis media affects about 5% or 31&nbsp;million of these cases with 22.6% of cases occurring annually under the age of five years.<ref name=Mon2012 /> Otitis media resulted in 2,400 deaths in 2013{{snd}}down from 4,900 deaths in 1990.<ref name=GBD204/>

[[Australian Aboriginal]]s experience a high level of [[conductive hearing loss]] largely due to the massive incidence of middle ear disease among the young [[indigenous health in Australia|in Aboriginal communities]]. Aboriginal children experience middle ear disease for two and a half years on average during childhood, compared with three months for non indigenous children. If untreated, it can cause permanent hearing loss.<ref>{{Cite journal |url=https://search.informit.com.au/documentSummary;dn=227116693879365;res=IELAPA |title=Damien Howard & Dianne Hampton, "Ear disease and Aboriginal families," ''Aboriginal and Islander Health Worker Journal'', July-August 2006, 30 (4) p.9. |journal=Aboriginal and Islander Health Worker Journal |date=20 August 2020 |volume=30 |issue=4 |pages=9–11 |access-date=2023-09-06 |archive-date=2023-10-16 |archive-url=https://web.archive.org/web/20231016145358/https://search.informit.org/doi/10.3316/INFORMIT.227116693879365 |url-status=live | vauthors = Howard D, Hampton D }}</ref> The higher incidence of deafness in turn contributes to poor social, educational, and emotional outcomes for the children concerned. Such children, as they grow into adults, are also more likely to experience employment difficulties and find themselves caught up in the criminal justice system. Research in 2012 revealed that nine out of ten Aboriginal prison inmates in the [[Northern Territory]] suffer from significant hearing loss.<ref>{{Cite web |url=https://www.theage.com.au/national/victoria/hearing-loss-hits-nt-indigenous-inmates-20120304-1ub4x.html |title=Farah Farouque, "Hearing loss hits NT indigenous inmates," ''The Age'', 5 March 2012 |date=4 March 2012 |access-date=6 September 2023 |archive-date=6 September 2023 |archive-url=https://web.archive.org/web/20230906094043/https://www.theage.com.au/national/victoria/hearing-loss-hits-nt-indigenous-inmates-20120304-1ub4x.html |url-status=live }}</ref>
Andrew Butcher speculates that the lack of [[fricative]]s and the unusual [[segment (linguistics)|segment]]al inventories of [[Australian Aboriginal languages|Australian languages]] may be due to the very high presence of otitis media ear infections and resulting hearing loss in their populations. People with hearing loss often have trouble distinguishing different vowels and hearing fricatives and [[Voice (phonetics)|voicing]] contrasts. Australian Aboriginal languages thus seem to show similarities to the speech of people with hearing loss, and avoid those sounds and distinctions which are difficult for people with early childhood hearing loss to perceive. At the same time, Australian languages make full use of those distinctions, namely place of articulation distinctions, which people with otitis media-caused hearing loss can perceive more easily.{{sfn|Butcher|2018}} This hypothesis has been challenged on historical, comparative, statistical, and medical grounds.<ref>{{cite thesis |last=Fergus |first=Anelisa |date=2019 |title=Lend Me Your Ears: Otitis Media and Aboriginal Australian languages |url=https://ling.yale.edu/sites/default/files/files/Anelisa%20Fergus.pdf |type=BA |access-date=2023-09-06 |archive-date=2023-10-10 |archive-url=https://web.archive.org/web/20231010080239/https://ling.yale.edu/sites/default/files/files/Anelisa%20Fergus.pdf |url-status=live }}</ref>

==Etymology==
The term ''otitis media'' is composed of ''otitis'', [[Ancient Greek]] for "inflammation of the ear", and ''media'', [[Latin]] for "middle".

== References ==
{{Reflist}}
* {{cite conference 
|last1=Butcher 
|first1=Andrew R. 
|title=The special nature of Australian phonologies: Why auditory constraints on human language sound systems are not universal 
|series=177th Meeting of the Acoustical Society of America 
|date=2018 
|doi=10.1121/2.0001004
|doi-access=free
|publisher=Acoustical Society of America
|conference=176th Meeting of Acoustical Society of America
|book-title=Proceedings of Meetings on Acoustics
|volume=35
|page=060004 
}}

== External links ==
* {{cite journal | vauthors = Neff MJ | title = AAP, AAFP, AAO-HNS release guideline on diagnosis and management of otitis media with effusion | journal = American Family Physician | volume = 69 | issue = 12 | pages = 2929–2931 | date = June 2004 | pmid = 15222658 | url = https://www.aafp.org/afp/2004/0615/p2929.html }}
{{Medical condition classification and resources
 | DiseasesDB     = 29620
 | DiseasesDB_mult= serous,<br />{{DiseasesDB2|9406}} suppurative
 | ICD10          = {{ICD10|H|65||h|65}}–{{ICD10|H|67||h|65}}
 | ICD9           = {{ICD9|017.40}}, {{ICD9|055.2}}, {{ICD9|381.0}}, {{ICD9|381.1}}, {{ICD9|381.2}}, {{ICD9|381.3}}, {{ICD9|381.4}}, {{ICD9|382}}
 | ICDO           =
 | OMIM           =
 | MedlinePlus    = 000638
 | MedlinePlus_mult= acute, {{MedlinePlus2|007010}} with effusion, {{MedlinePlus2|000619}} chronic
 | eMedicineSubj  = emerg
 | eMedicineTopic = 351
 | eMedicine_mult = <br />{{eMedicine2|ent|426}} complications, {{eMedicine2|ent|209}} with effusion, {{eMedicine2|ent|212}} Medical treat., {{eMedicine2|ent|211}} Surgical treat. {{eMedicine2|ped|1689}}
 | MeshID         = D010033
}}
{{Commons category|Otitis media}}

{{Diseases of the ear and mastoid process}}
{{Common Cold}}

{{Authority control}}

{{DEFAULTSORT:Otitis Media}}
[[Category:Otitis]]
[[Category:Diseases of middle ear and mastoid]]
[[Category:Pediatrics]]
[[Category:Audiology]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia emergency medicine articles ready to translate]]

[[fr:Otite]]
[[Category:Otorhinolaryngology]]
[[Category:Otology]]