Classification of otitis media and surgical principles

Otitis media is an important disease of children and adults and is caused by multiple interrelated factors, including infection, ET dysfunction, allergy, and barotrauma. These factors stimulate middle ear mucosa and inflammatory cells to release inflammatory mediators, which, in turn, increase vascular permeability and secretory activity, resulting in MEEs. The stages of OM may not only overlap and interchange between POM, SOM, and MOM but also may progress from any stage in a continuum toward COM without timely intervention. The treatment of patients with OM varies according to the type and stage of disease. The primary treatment of patients with AOM is systemic antibiotics, adding tympanocentesis when bacterial identification is required. For patients with recurrent AOM, appropriate therapy includes chemoprophylaxis, vaccination, myringotomy with insertion of tympanostomy tubes, or adenoidectomy. Tympanostomy tubes prevent and relieve barotrauma in patients receiving hyperbaric oxygen therapy. Current evidence suggests that repeated myringotomies or observation are preferable to the placement of tympanostomy tubes, for treating the SOM that follows radiation therapy. For patients with OME, antibiotic therapy is the only nonsurgical treatment modality shown to be effective. Following a course of antibiotics, if the MEE persists beyond 3 months, surgical options include placement of tympanostomy tubes, adenoidectomy, or adenoidectomy plus myringotomy or tubes. The primary treatment modality for patients with COM is surgery, which is necessary to eradicate disease and reconstruct the hearing mechanism.