It would be helpful to have read the chapter about the ear as this will make it easier to understand this chapter.
Middle ear disease is usually referred to as Otitis Media [OM]. Most people use the term OM to mean ear infection, but OM actually means ‘inflammation of the middle ear’. Although OM is commonly caused by infection there can be other causes of inflammation.
INCIDENCE OF OM
Otitis media is an extremely common condition in the community. About 80 percent of children will have at least one bout of OM before the age of three. In our community, OM is the most common reason for a child under three years of age visiting a GP. Some children will only have one episode of ear infection during their childhood but others may have repeated or continuing problems over months or years.
Infants with Eustachian tube Irritation [ETI] have bouts of ear infection and effusions unrelated to the season.
Older children have more frequent episodes during the winter because of the increased incidence of ear infections related to colds. At any time during the winter approximately 15 percent of children in kindy and early school years will have a middle ear problem. Six weeks later the incidence will still be about 15 percent but some of the children will have recovered and other children will be affected. In an average class of 30 children, about four or five children will be recovering from a bout of ear infection or have hearing loss related to a middle ear problem. Teachers are unlikely to know which children are affected as there is unlikely to be obvious evidence that there is a problem.
In many indigenous communities the incidence of middle ear problems is much, much higher. OM is the scourge of indigenous children. In some classrooms, 90 percent of the children will have either active middle ear problems, hearing loss from middle ear problems, or a combination of active problems and permanent damage.
OM is accepted as being a huge problem in indigenous communities—in the Australian indigenous community and other indigenous communities around the world [e.g., Inuit, Maori and American native communities]. Because the incidence is so high in these communities some people discount the severity and major implications of the OM problem in the rest of the community.
I suspect that because the condition is so common, some parents and some GPs are very blasé about OM. Nonetheless OM is a huge cause of morbidity [i.e., reduced quality of life] in the community. It has the potential for many sequelae, including delayed language development, behavioural problems, emotional issues and school learning problems.
The long term sequelae for children who have significant middle ear problems may mean a life time of issues and the risk that they will not reach their intellectual potential….
OM is a large problem for some children in the non-indigenous community and an even greater problem in the indigenous community.
About 80 percent of children will have at least one episode of OM in their life time. Some will have ongoing problems over several years. The majority of children outgrow the problem by about three years, some continue until about eight. The majority will have outgrown the problem before reaching puberty and a very small number will continue into adult life still having middle ear problems. The problems settle because of improvement in the function of the ETs and an improvement in immunity.
OM can be divided into several categories: AOM, Recurrent AOM, MEE, dry perforation of the ear drum and chronic discharge from the ME.
Each of these categories is discussed in detail—the classical and less common presentations, the diagnosis and implications for later.
Treatment is described later in the chapter about Treatmen s….