Otitis media natural history, complications and prognosis

The prognosis of otitis media is usually good with or without treatment, but varies based on the classification. Acute otitis media is self-limited and usually resolves itself within 14 days, and otitis media with effusion will usually resolve itself within 3-6 months. Chronic suppurative otitis media will usually require surgical or antibiotic intervention to alleviate symptoms and resolve the disease. Acute otitis media rapidly follows the onset of nasopharyngitis; otitis media with effusion and chronic suppurative otitis media may develop following the resolution of acute otitis media symptoms and have a longer symptomatic duration. Complications of otitis media result from the spread of causative infection, as well as damage to the tympanic membrane due to fluid buildup and pressure changes. Presence of complications can increase the morbidity in otitis media patients and worsen the prognosis.

• Onset of otitis media rapidly follows the onset of the causative nasopharyngitis.^[1]
  • Otitis media onset manifests through symptoms including ear pain, fever, tympanic effusion, headache, cough, and nasal discharge.
• Without treatment, acute otitis media (AOM) will usually resolve between 7 and 14 days.^[2]
  • 80% of children with AOM will experience symptomatic relief without treatment within 2-3 days.
• Otorrhea will usually take longer than symptoms such as fever or ear pain to resolve.^[2]
• Otitis media with effusion (OME) will resolve itself without treatment in a period of 3-6 months.^[2]
  • Complete clearance of middle ear effusion will take longer than symptomatic effects of otitis media due to longer duration of fluid drainage.
• Chronic suppurative otitis media will not usually resolve itself and will remain and recur indefinitely without surgical intervention.^[3]
  • Symptoms of acute otitis media will recur indefinitely, heightening risk of complications.

• Complications of otitis media result from the spread of causative infection, as well as damage to the tympanic membrane due to fluid buildup and pressure changes.
• Intracranial and extracranial complications of otitis media include the following:^[4]
  • Meningitis: the pathogen causing otitis media can spread to the meninges and cause inflammation.
  • Brain abscess: result of inflammation from infection spreading to the brain.
  • Mastoiditis: infection of the mastoid bone behind the ears caused by the otitis media pathogen.^[5]
  • Sigmoid sinus thrombosis: otitis media can result in thrombosis of the cerebral veins and sinuses in rare cases.^[6]
  • Partial hearing loss.^[7]
  • Tympanic injury requiring surgical reconstruction.^[7]

• The prognosis of otitis media is usually good without treatment.
  • Acute otitis media will usually resolve itself within 2 weeks.
  • Otitis media with effusion will usually resolve itself within 3 months.
• Prognosis of chronic suppurative otitis media without treatment varies on the presence of complications.^[8]
  • Complications of mastoiditis and meningitis have poor prognosis without treatment.
• With treatment, all classifications of otitis media have a good prognosis.

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