What causes acute otitis media?

The most frequent pathogens of acute otitis media are Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae (haemophilus influenzae). A certain role is also played by viruses, primarily respiratory syncytial and Chlamydia pneumoniae.

Pneumococcus and hemophilic rod are highly sensitive to beta-lactams and cephalosporins, but 35% of all pneumococci and 18% of hemophilic rods are resistant to co-trimoxazole.

The causative agents of acute otitis media in children

Causative agent	%
H. Influenzae	37.8
S. Pneumoniae	30.0
S. Pyogenes	5.6
S. Aureus	3.3
Other	2.2
M. Calarrhalis	1.1
H. Influenzae + S. Pneumoniae	7.8

The sensitivity of S. Pneumoniae and H. Influenzae to antibacterial drugs

Antibiotic	Sensitivity of S. Pneumoniae	The sensitivity of H. Influenzae
Penicillin	97.1	-
Ampicillin	97.1	97.6
Amoxicillin / Clavunate	100	100
Cefaclor	100	97.6
Cefuroxime	100	100
Ceftriaxone	100	100
Erythromycin	97.1	-
Azithromycin	97.1	100
Co-trimoxazole	64.6	82.3

Acute inflammation of the middle ear is more likely to affect boys. The highest frequency

S. Pyogenes	5.6
S. Aureus	3.3
Other	2.2
M. Calarrhalis	1.1

It is proved that the inflammation of the middle ear is more common in children sleeping on their stomachs than those sleeping on their backs. Children attending children's groups notice a high incidence of acute otitis media.

To the local premises conducive to the disease of acute otitis media, the features of the auditory tube include: the child is short, wider than the adult, more straight, horizontal, the epithelium (cylindrical) is not sufficiently developed, this promotes stagnation in the tympanic cavity. After birth, a loose, vascular-rich connective tissue (the so-called myxoid), a good nutrient medium for the growth of microorganisms, still remains for a while in the tympanum. In the nasopharynx in infants, a violation of microcirculation is often observed. In combination with the typical overgrowth of lymphoid tissue typical for childhood, a significantly higher incidence of acute otitis media in children (compared to adults) becomes understandable.

The main cause of acute catarrhal otitis media is dysfunction of the auditory (Eustachian) tube, most often associated with acute edema of its mucous membrane.

Of the causes of latent otitis media, it should first be noted that it is more common in infancy and is associated with common diseases (viral infection, sepsis, bronchopulmonary and digestive system diseases), general developmental disorders (prematurity, rickets, artificial feeding, hypotrophy); an allergy.

The causes of recurrence of otitis media, sometimes they develop up to 5-8 times a year, can be local and common. The latter include frequent pneumonia, digestive and nutritional disorders, allergies, etc. Local causes are increased adenoid vegetations, polyps of the nose, sinusitis, hypertrophy of nasal conchae and palatine tonsils.

Recently, the interest of pediatricians in this disease has grown significantly. This is explained by advances in clinical microbiology, new data on the pharmacodynamics of antibiotics in children with otitis media.

Pathogenesis of acute otitis media

There is a classical pattern of acute otitis media. There are three stages in it: the first - the initial development of the process, the second - after the onset of perforation and the third - recovery. Each of them lasts about a week. At the first stage, there is pain, high fever, hearing loss, hyperemia of the tympanic membrane, general intoxication, reaction from the periosteal mastoid process. At the second stage, after the onset of perforation, the symptoms change: spontaneously the pain decreases, the temperature and intoxication decrease, there are discharge from the ear, otoscopy reveals the perforation of the tympanic membrane, the hearing loss remains the same. At the third stage, the temperature is normalized, intoxication disappears, pain is absent, discharge stops, perforation cicatrizes, hearing is restored.

Acute inflammation of the middle ear can occur in two versions: catarrhal and purulent. The first disease is known as "catarrhal otitis media".

Acute catarrhal inflammation of the middle ear can be delayed and become chronic. This is due to the delay in evacuating the secret from the tympanum. The main reason for the transition to a chronic process in childhood is the pathology of the nasopharynx, primarily hypertrophy of the nasopharyngeal tonsil (adenoids). Thus, if it is not possible to restore hearing by simple procedures, produce adenotomy, and sometimes shunting the tympanum.