Jiménez CA, Vera De AM, Bross SD,Castro HG, Valle AEP, Prado CHM, Arrieta GJ

Language: Spanish
References: 10
Page: 14-20
PDF size: 193.58 Kb.

ABSTRACT

Introduction: Acute otitis media (AOM) is one of the most frequently diagnosed infectious diseases, it is generally self-limited and some controversies exist in diagnostic methods, prevention and treatment.
Objective: Current trends on epidemiology, fisiopathology, diagnosis, treatment, prevention and complications will be presented.
Material and methods: Review of the actual literature on books, medical magazines and Internet consulting.
Epidemiology: AOM is more frequent in winter months and affects mostly pediatric patients.
Fisiopathology: It is tightly associated with anatomy and function of the Eustachian tube.
Microbiology: The most prevalent infectious agents are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, although other microorganisms have been implied.
Clinical stages: The disease courses through 5 clinical stages: tubotympanitis, hyperemic, exudative, supurative and acute mastoiditis.
Diagnosis: It is mostly clinical, even if some otoneurological tests like pure tone audiometry and impedance tests may be useful.
Treatment: Initially with antibiotics that are empirically directed against the most frequent isolated pathogens. It is important to consider the appearance of new B-lactamase producing microorganisms. Decongestants, antihistamines and steroids have not proved their efficiency.
Prevention: The most recent research is focused in the development of new preventive strategies like the new specific recombinant pneumococcical vaccine.
Complications: They are classified as intracranial and intratemporal, impedance, audiometry.
Conclusions: The costs in the management of this clinical entity are high. It is important to have an adequate antibiotic treatment to avoid the development of new resistant strains and prevent complications.

REFERENCES

1. Sloan B. Primary Care, Clinics in office practice 1998: 25-3.

2. Haddad J et al. Treatment of acute otitis media and its complications. The otolaryngologic clinics of North America. Pediatric Otology 1998: 25:3.

3. Jung H. Classification of otitis media and surgical principles. The otolaryngologic clinics of North America. Otitis Media 1999: 32.

4. Poole MD. Appropriate antibiotic use in treating respiratory tract infections. Am J Manag Care 2001; 7: 6 supl.

5. Flynn CA et al. Decongestants and antihistamines for acute otitis media in children. Cochrane database Syst Rev 2001; 2 CD 0017227.

6. Butler CC et al. Steroids for otitis media with effusion a systematic review. Arch Pediatr Adolesc Med 2001; 155(6): 636.

7. Cummings CW et al. Otolaryngology Head and Neck Surgery. Acute otitis media and otitis media with effusion. Gates G.3 ed. EUA. Mosby 1998.

8. Bailey BJ et al. Head and Neck Surgery-Otolaryngology 2 ed. EUA. Lippincot-Raven 1998.

9. Bluestone CD, Stephenson JS, Martín LM. Ten years review of otitis media pathogens. Pediatr Infect Dis J 1992; 11(8 supl).

10. Dowel S et al. Otitis media, principles of judicious use of antimicrobial agents, Pediatrics 1998; 101: 1.