Classification of Otitis Media

The terminology in the literature associated with otitis media is complex and quite variable. Most classification systems for otitis media attempt to describe the disease process on the basis of the duration of the process, the type of inflammatory fluid involved, the presence of tympanic membrane perforation, the presence of suppurative or nonsuppurative disease and other criteria.6 The confusion in the literature regarding classification impedes our ability to describe the disease process and thus complicates clinical research and our ability to communicate effectively about otitis media.7

For the purposes of this chapter, the following terminology is used:

1. Acute otitis media: Suppurative or purulent middle ear process associated with purulent middle ear effusion with one or more of the following signs: otalgia, otorrhea, fever, and acute onset of irritability. Otoscopic findings demonstrate purulent middle ear effusion and a bulging tympanic membrane with loss of tympanic landmarks; possibly with the presence of an acute draining perforation.

2. Recurrent acute otitis media: Repetitive bouts of acute otitis media, separated by asymptomatic periods and clearing of middle ear effusion.

3. Chronic otitis media with effusion: The presence of middle ear effusion, regardless of symptomatology, that has been present for 90 days or longer. The fluid may be categorized into serous, purulent, or mucoid middle ear effusion.

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