Diagnostic Similarities and Differences between Acute Otitis Media and Otitis Media with Effusion

Otalgia, Impaired

Fever, Middle Ear Opaque Bulging Drum Hearing

Irritability Effusion Drum Drum Mobility Loss

Acute otitis media Present Present Present Present Present Present

Otitis media with effusion Absent Present May be absent Usually absent Present Usually

(air-fluid level) present

Susceptibility Of S. pneumonía« to Penicillin G in Middle Ear Effusion Children's Hospital of Pittsburgh 19BS-1997

Susceptibility Of S. pneumonía« to Penicillin G in Middle Ear Effusion Children's Hospital of Pittsburgh 19BS-1997

■ saa 1969 1S9Û 1991 1SS2 1Í9S 1SS4 lääi 1ÏM I9â/

Figure 78-1 Prevalence of penicillin-resistant Pneumococcus isolated from the middle ears of infants and children at the Children's Hospital of Pittsburgh from 1988 to 1997.

■ saa 1969 1S9Û 1991 1SS2 1Í9S 1SS4 lääi 1ÏM I9â/

Figure 78-1 Prevalence of penicillin-resistant Pneumococcus isolated from the middle ears of infants and children at the Children's Hospital of Pittsburgh from 1988 to 1997.

increased from approximately 10% in 1988 to more than 40% in 1997, and more than one-half of these strains were highly resistant; most likely the rate is lower in community practices (Fig. 78-1).

In contrast to acute otitis media, bacteria considered to be potentially pathogenic can be isolated from only one-third of middle-ear aspirates from patients who have otitis media with effusion. Similar to isolates from acute otitis media, the most common are S. pneumoniae, H. influenzae, and M. catarrhalis, but the latter two organisms are more commonly isolated than pneumococcus.4 Resistance rates of these organisms are similar to rates found when these bacteria cause acute otitis media. Recently, these three bacteria have been detected by polymerase chain reaction (PCR) in approximately 70% of chronic middle ear effusions at the time of myringotomy and tympanostomy tube insertion; only about one-third of the organisms were identified using traditional culture methods.5'6

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