Surgical Myringotomy with Tube Insertion Age 017

Otitis media, the most common cause of antibiotic prescription in the United States, is an infection of the middle ear that can occur in several forms. Acute otitis media (AOM) is a suppurative (pus-forming) effusion of the middle ear with acute onset, presence of middle ear effusion (MEE), and signs of middle ear inflammation. Bullous myringitis is AOM that leads to bullae formation between the middle and the inner layers of the tympanic membrane. Persistent otitis media occurs when an acute infection does not resolve after 4 weeks of treatment. Recurrent otitis media occurs in children with three separate bouts of AOM within a 6-month period, six within a 12-month period, or six episodes by 6 years of age. Ostitis media is common, and at least half of children have their first epidose prior to their first birthday.

The eustachian tube protects the middle ear from secretions and allows for drainage of secretions into the nasopharynx. It also permits equalization of air pressure with atmospheric pressure in the middle ear. A mechanical obstruction of the eustachian tube can result in infection and middle ear effusion. A functional obstruction can occur with persistent collapse of the eustachian tubes, particularly in infants and young children, because the amount and stiffness of their cartilage is less than that of older children and adults. Eustachian tube obstruction leads to negative middle ear pressure and a sterile MEE. Drainage of the effusion is inhibited by impaired mucociliary action and sustained negative pressure. Contamination of the middle ear may occur from nasopharyngeal secretions and lead to infection. Because infants and young children have a shorter eustachian tube than older children, it makes them more susceptible to reflux of nasopharyngeal secretions into the middle ear and development of infection. Other predisposing factors include upper respiratory infections, allergies, Down syndrome, bottle propping during feedings, daycare attendance, and parental smoking. Complications include persistent AOM, tympanic membrane perforation, mastoiditis, hearing loss for several months, speech delay, and cerebral thrombophlebitis.

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