Progress in Understanding the Pathophysiology of Otitis Media
G. Scott Giebink MD1
1 Professor of Pediatrics and Otolaryngology and Director, Otitis Media Research Center, University of Minnesota School of Medicine, Minneapolis. Address for reprints: Box 483 UMHC, 420 Delaware St SE, Minneapolis, MN 55455
Otitis media is one of the most common diseases of infants and young children, and its complications and sequelae may persist into adult years. The disease affects at least 7 of every 10 children, with one third of those affected having repeated episodes, and chronic middle ear disease, commonly called otitis media with effusion, developing in 5% to 10% of them.
The management of childhood otitis media has changed considerably during the past five decades. Before the introduction of antimicrobial drugs, myringotomy was, and in some countries remains today, the treatment of choice. The introduction of sulfonamides and penicillin four decades ago and their widespread use in treating acute otitis media led to a great reduction in the incidence of suppurative complications. Of the new orally administered antibiotics, many have been found to be efficacious in treating acute otitis media. Sophisticated methods of measuring treatment outcome suggest, however, that there are differences in rates of bacteriologic response to these drugs. Moreover, adjunctive therapies such as decongestants, antihistamines, steroidal and nonsteroidal anti-inflammatory drugs, and topical drugs, in addition to myringotomy and adenoidectomy, have been advocated by some in treating acute and recurrent otitis media. These newer therapeutic interventions have led to controversies regarding management of the disease.
