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Chapter 031. Pharyngitis, Sinusitis, Otitis, and Other Upper Respiratory Tract Infections (Part 8)

Serous Otitis Media In serous otitis media (otitis media with effusion), fluid is present in the middle ear for an extended period and in the absence of signs and symptoms of infection. In general, acute effusions are self-limited; most resolve in 2–4 weeks. In some cases, however (in particular after an episode of acute otitis media), effusions can persist for months. These chronic effusions are often associated with a significant hearing loss in the affected ear. In younger children, persistent effusions and decreased hearing can be associated with impairment of language acquisition skills. The great majority of cases of. | Chapter 031. Pharyngitis Sinusitis Otitis and Other Upper Respiratory Tract Infections Part 8 Serous Otitis Media In serous otitis media otitis media with effusion fluid is present in the middle ear for an extended period and in the absence of signs and symptoms of infection. In general acute effusions are self-limited most resolve in 2-4 weeks. In some cases however in particular after an episode of acute otitis media effusions can persist for months. These chronic effusions are often associated with a significant hearing loss in the affected ear. In younger children persistent effusions and decreased hearing can be associated with impairment of language acquisition skills. The great majority of cases of otitis media with effusion resolve spontaneously within 3 months without antibiotic therapy. Antibiotic therapy or myringotomy with insertion of tympanostomy tubes is typically reserved for patients in whom bilateral effusion 1 has persisted for at least 3 months and 2 is associated with significant bilateral hearing loss. With this conservative approach and the application of strict diagnostic criteria for acute otitis media and otitis media with effusion it is estimated that 6-8 million courses of antibiotics could be avoided each year in the United States. Chronic Otitis Media Chronic suppurative otitis media is characterized by persistent or recurrent purulent otorrhea in the setting of tympanic membrane perforation. Usually there is also some degree of conductive hearing loss. This condition can be categorized as active or inactive. Inactive disease is characterized by a central perforation of the tympanic membrane which allows drainage of purulent fluid from the middle ear. When the perforation is more peripheral squamous epithelium from the auditory canal may invade the middle ear through the perforation forming a mass of keratinaceous debris cholesteatoma at the site of invasion. This mass can enlarge and has the potential to erode bone and promote further