Otitis media classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Otitis media can be classified into acute, effusive, and chronic suppurative forms. Their clinical presentations will vary based on the different symptoms. The treatment necessity will also vary based on classification.

Otitis media can be divided into 3 subtypes, differentiating in their clinical presentation.

• Acute otitis media (AOM) is primarily caused by viral or bacterial infection due to nasopharyngitis.^[1]
• If caused by a virus, it is usually self-limited and will typically resolve itself without treatment.^[2]
• Antibiotics may be necessary for AOM caused by bacterial infection.
• Symptoms are usually present and are similar to those from upper respiratory infection, include the following:
  • Fever
  • Ear pain
  • Vomiting
  • Diarrhea
  • Common cold symptoms
  • Mild hearing loss
• Can result in infection-based complications, such as meningitis and mastoiditis.

• Otitis media with effusion (OME) is non-infectiously caused otitis media based on fluid buildup in the eustachian tube.^[3]
• It is usually caused by irritants, allergies, or upper respiratory infection that does not infect the ear itself.
• The fluid buildup may remain trapped in the middle ear preceding or following acute otitis media.
• Symptoms usually include partial hearing loss and feelings of “fullness” in the ear, but do not usually present pain, common cold symptoms, fever, or other indicators of illness that is common in AOM.
• OME is usually self-limited and does not require treatment to resolve itself.

• Chronic suppurative otitis media (CSOM) is usually classified by the persistence of pus discharge due to tympanic perforation from acute otitis media for 6-12 weeks following treatment.^[4]
• The symptoms are similar to those of AOM, but persist due to the resistant active bateria causing suppuration in the ear, heightening the risk of temporary and permanent hearing loss.^[5]
• Treatment is required and will vary due to severity:
  • Antibiotics: ciprofloxacin and gentamicin
  • Mastoidectomy
  • Tympanoplasty
  • Middle ear irrigation
• CSOM can result in otorrhea and can be classified by visible pus discharge outside of the middle ear.

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