Sunday, January 15, 2006

otitis media

Otitis media, infection of the middle ear, occurs primarily in childhood but can extend into adulthood, becoming chronic. Incidence of otitis media increase with the occurence of upper respiratory infections. Respiratory infections occur most frequently in those with the least resistance (the very young and very old) and therefore the incidence of otitis media tends to increase as individuals age.
The onset of chronic ear disease is insidious. The patient usually presents with fully developed symptomatic disease with pain and decreased hearing.
Chronic disease of the middle ear has two aspects. The primary disability is due to continuing or recurrent infection of the ear with the symptoms of drainage from the ear. The second area of disability is the attendant loss of hearing due to damage to the sound conduction mechanism and to cochlear damage from toxicity or direct extension of the infectious process.
Culture and sensitivity tests may be indicated, especially if antibiotics have been used for prolonged periods. Corticosteroids may be added to antibiotics to control local allergic manifestations. The addition of heparin is of value to control local histamine response in the tissues. Systemic antibiotics are indicated in acute infections superimposed on the chronic infection. Alcohol should not be used in strengths greater than 70 percent since it is both irritating and painful.
Surgical intervention is indicated in cases with: presence of threatened or an actual complication; presence of irreversible pathologic conditions in the mastoid of middle ear, such as osteomyelitis (bone inflammation), cholesteatoma (cystlike mass), or sequestration (formation of dead bone); lack of response to an adequate medical regimen. Surgical reconstruction, eradication of irreversible disease, and adequate drainage result in the possibility of aural rehabilitation for many individuals suffering from chronic ear diseases.
Ballenger, J. J. Diseases of the Nose, Throat, Ear, Head and Neck, 13th ed. Philadelphia: Lea & Febiger, 1985.


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