Clinical Information

Otitis media is an infection of the middle ear and is one of the most common reasons children under 5 visit the pediatrician's office. More than 80% of children have one or more episodes of otitis media by age 6 years, with the highest number of cases between 2 and 6 years of age. Hearing loss and deficits in learning are a few of the complications. The most common agents otitis media are Streptococcus pneumoniae, Haemophilus influenzae, Morexella catarrhalis, and Alloiococcus otitis, although Streptococcus pyogenes is found on a seasonal basis. Otitis externa is an infection of the external auditory canal. Unique problems occur with this infection because of the narrow and tortuous nature of the canal and its tendency to trap foreign objects, wax, and water. Infections are classified as acute and chronic. Acute infections are often referred to as "swimmer's ear". Pseudomonas aeruginosa is a frequent cause of freshwater otitis, and Vibrio alginolyticus is a cause in oceanic swimmers, although other aerobic bacteria can be involved. Localized infections with Staphylococcus aureus and S pyogenes can also occur. Contaminating skin bacterial microbiota (corynebacteria and staphylococci) can be present, which are not significant. More invasive infections are caused by extension of bacteria into the adjacent soft tissues and bone, with the formation of a cholesteatoma. Chronic otitis is usually caused by bacterial infection, and, although P aeruginosa may be predominating, a variety of anaerobes may also be present. Tissue and bone samples from the inner ear should also be cultured for fungi, Nocardia, and mycobacteria which may also be etiologic agents of chronic infection.