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Otitis Media: Basic Concepts and Fundamentals

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Textbook of Otitis Media

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Abstract

Otitis media is a multifaceted pathology, and, therefore, its complete understanding can only be achieved through analysis and meticulous study of each of its small facets. These studies will have to be skilled enough to dissect the individual aspects of this disease without, however, denying the fact that they are organically and evolutionarily interconnected. Analogously, it would be as if we tried to understand a chain by examining only one of its links and extrapolating that to include every form of the disease. For this reason, we will dedicate the next paragraphs to dive deeper into the basic science concepts that we consider essential for addressing issues relevant to the etiology, classification, pathogenesis, and treatment of this prevalent disease.

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References

  1. Brown OE, Meyerhoff WL. Complications and sequelae of chronic suppurative otitis media. Ann Otol Rhinol Laryngol. 1988;97(131):38–40.

    Article  Google Scholar 

  2. Costa SS. Contribution to the study of chronic otitis media. Masters dissertation, Faculty of Medicine of Ribeirão Preto, USP. 1991.

    Google Scholar 

  3. Meyerhoff WL, Kim CG, Paparella MM. Pathology of chronic otitis media. Ann Otol Rhinol Laryngol. 1978;87(6):749–61.

    Article  PubMed  CAS  Google Scholar 

  4. Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, Grasso D, Barbiero C, Tamburlini G. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One. 2012;7(4):e36226. https://doi.org/10.1371/journal.pone.0036226. Epub 2012 Apr 30. PMID: 22558393; PMCID: PMC3340347.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Ohashi Y, Nakai Y, Ikeoka H, Esaki Y, Koshimo H, Onoyama Y. Mucosal pathology of an experimental otitis media with effusion after x-ray irradiation. Am J Otol. 1987;8:223–35.

    Article  CAS  Google Scholar 

  6. Schilder AG, Chonmaitree T, Cripps AW, Rosenfeld RM, Casselbrant ML, Haggard MP, Venekamp RP. Otitis media. Nat Rev Dis Primers. 2016;2(1):16063. https://doi.org/10.1038/nrdp.2016.63. PMID: 27604644; PMCID: PMC7097351.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hoffman HJ, Daly KA, Bainbridge KE, Casselbrant ML, Homøe P, Kvestad E, Kvaerner KJ, Vernacchio L. Panel 1: Epidemiology, natural history, and risk factors. Otolaryngol Head Neck Surg. 2013;148(4 Suppl):E1–E25. https://doi.org/10.1177/0194599812460984. PMID: 23536527.

    Article  PubMed  Google Scholar 

  8. Hu T, Done N, Petigara T, Mohanty S, Song Y, Liu Q, Lemus-Wirtz E, Signorovitch J, Sarpong E, Weiss T. Incidence of acute otitis media in children in the United States before and after the introduction of 7- and 13-valent pneumococcal conjugate vaccines during 1998–2018. BMC Infect Dis. 2022;22(1):294. https://doi.org/10.1186/s12879-022-07275-9. PMID: 35346092; PMCID: PMC8962537.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hu T, Podmore B, Barnett R, Beier D, Galetzka W, Qizilbash N, Haeckl D, Weaver J, Boellinger T, Mihm S, Petigara T. Incidence of acute otitis media in children <6 years old in Germany during 2014–2019. BMC Pediatr. 2022;22(1):204. https://doi.org/10.1186/s12887-022-03270-w. PMID: 35418046; PMCID: PMC9006409.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kvaerner KJ, Tambs K, Harris JR, Magnus P. Distribution and heritability of recurrent ear infections. Ann Otol Rhinol Laryngol. 1997;106(8):624–32.

    Article  PubMed  CAS  Google Scholar 

  11. Lanphear BP, Byrd RS, Auinger P, Hall CB. Increasing prevalence of recurrent otitis media among children in the United States. Pediatrics. 1997;99(3):E1.

    Article  PubMed  CAS  Google Scholar 

  12. Jefferson ND, Hunter LL. Contemporary guidelines for tympanostomy tube placement. Curr Treat Options Pediatr. 2016;2:224–35. https://doi.org/10.1007/s40746-016-0055-7.

    Article  Google Scholar 

  13. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report. 2009;11:1–25.

    Google Scholar 

  14. Bluestone CD, Gates GA, Klein JO, et al. Definitions, terminology, and classification of otitis media. Ann Otol Rhinol Laryngol. 2002;111(3_suppl):8–18. https://doi.org/10.1177/00034894021110S304.

    Article  Google Scholar 

  15. Lim D, Jackson D, Bennet J. Human middle ear corpuscles: a light and electron microscopic study. Laryngoscope. 1975;85:1725–37.

    Article  PubMed  CAS  Google Scholar 

  16. Paparella MM, Goycoolea MV, Bassiouni M, Koutroupas S. Silent otitis media. Clinical applications. Laryngoscope. 1986;96(9):978–85.

    Article  PubMed  CAS  Google Scholar 

  17. Senturia BH, Bluestone CD, Lim DJ, Klein JO, Paradise JL. Report of the AD HOC Committee on definition and classification of otitis media and otitis media with effusion. Ann Otol Rhinol Laryngol. 1980;89(3_suppl):3–4. https://doi.org/10.1177/00034894800890S303.

    Article  Google Scholar 

  18. Contran RS, Kumar V, Robbins. Robbins pathologic basis of disease. 5th ed. Saunders; 1994.

    Google Scholar 

  19. Schaechter M. Establishment of infectious diseases. In: Johnson JT, Yu VL, editors. Infections diseases and antimicrobial therapy of the ears, nose and throat, Chap 3. Saunders; 1997. p. 3–8.

    Google Scholar 

  20. Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM. Otitis media. Lancet. 2004;363(9407):465–73. https://doi.org/10.1016/s0140-6736(04)15495-0.

    Article  PubMed  Google Scholar 

  21. Homøe P. Recurrent otorrhea in chronic suppurative otitis media: is biofilm the missing link? Eur Arch Otorhinolaryngology. 2017;274(7):2741–7. https://doi.org/10.1007/s00405-017-4586-8.

    Article  Google Scholar 

  22. Cayé-Thomasen P, Hermansson A, Bakaletz L, Hellstrøm S, Kanzaki S, Kerschner J, et al. Panel 3. Otolaryngol Head Neck Surg. 2013;148(4_Suppl):E37–51. https://doi.org/10.1177/0194599813476257.

    Article  PubMed  Google Scholar 

  23. Mittal R, Lisi CV, Gerring R, Mittal J, Mathee K, Narasimhan G, Azad RK, Yao Q, Grati M, Yan D, Eshraghi AA, Angeli SI, Telischi FF, Liu XZ. Current concepts in the pathogenesis and treatment of chronic suppurative otitis media. J Med Microbiol. 2015;64(10):1103–16. https://doi.org/10.1099/jmm.0.000155. Epub 2015 Aug 5. PMID: 26248613; PMCID: PMC4835974.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jotic A, Jesic S, Zivkovic M, Tomanovic N, Kuveljic J, Stankovic A. Polymorphisms in Toll-like receptors 2 and 4 genes and their expression in chronic suppurative otitis media. Auris Nasus Larynx. 2015;42(6):431–7. https://doi.org/10.1016/Jan.anl.2015.04.010. Epub 2015 Jun 6. PMID: 26055429.

    Article  PubMed  Google Scholar 

  25. Santos-Cortez RLP, Ehrlich GD, Ryan AF. Editorial: Otitis media genomics and the middle ear microbiome. Front Genet. 2021;12:763688. https://doi.org/10.3389/fgene.2021.763688. PMID: 34712274; PMCID: PMC8546293

    Article  PubMed  PubMed Central  Google Scholar 

  26. Thornton RB, Hakansson A, Hood DW, Nokso-Koivisto J, Preciado D, Riesbeck K, Richmond PC, Su YC, Swords WE, Brockman KL. Panel 7 - Pathogenesis of otitis media - a review of the literature between 2015 and 2019. Int J Pediatr Otorhinolaryngol. 2020;130(Suppl 1):109838. https://doi.org/10.1016/j.ijporl.2019.109838. Epub 2019 Dec 19. PMID: 31879085; PMCID: PMC7062565.

    Article  PubMed  Google Scholar 

  27. Kariya S, Okano M, Zhao P, Maeda Y, Kataoka Y, Higaki T, Nishizaki K. NLRP3 inflammasome expression in lipopolysaccharide-induced otitis media. Acta Oto-Laryngologica. 2019; https://doi.org/10.1080/00016489.2018.1515499.

  28. Lin S, Zhang W, Xu Y, Liu Q, Zhang W, Shao L. Gene expression analysis reveals immune and metabolic candidate pathways in the pathogenesis of chronic otitis media. Am J Transl Res. 2022;14(1):264–74. PMID: 35173843; PMCID: PMC8829611.

    PubMed  PubMed Central  CAS  Google Scholar 

  29. Preciado D, Granath A, Lin J, Val S, Kurabi A, Johnston N, Vijayasekaran S, Valdez T, Depireux D, Hermansson A. Panel 8: Report on recent advances in molecular and cellular biochemistry. Otolaryngol Head Neck Surg. 2017;156(4_Suppl):S106–13. https://doi.org/10.1177/0194599816658290. PMID: 28372528.

    Article  PubMed  Google Scholar 

  30. Kent GC. Comparative anatomy of the vertebrates. Saint Louis: The CV Mosby Co.; 1973. 414p

    Google Scholar 

  31. Baer JG. Cours d’anatomie comparée. Paris: Du Griffon, Neuchatel, Masson & CIE Editeurs; 1958. 206p

    Google Scholar 

  32. Romer AS, Parsons TS. The vertebrate body. Philadelphia: Sauders College Publishing; 1986. p. 679p.

    Google Scholar 

  33. Quay WB, Müller-Schwarze D. Functional histology of integumentary glandular regions in black-tailed deer (Odocoileus hemionus columbianus). J Mammal. 1970;51(4):675–94. https://doi.org/10.2307/1378294.

    Article  Google Scholar 

  34. Costa SS, Souza M, Silva DB. Compared anatomy of the hearing organs and their phylogeny. RBM-ORL. 1996;3(3):135–43.

    Google Scholar 

  35. Adams JG. LXXXI tuberculosis of the middle ear and the temporal bone. Ann Otol Rhinol Laryngol. 1948;57(4):980–3. https://doi.org/10.1177/000348944805700404.

    Article  PubMed  CAS  Google Scholar 

  36. Strickberger MW. Evolution. Saint Louis: Jones and Bartlett Publishers; 1989. 569p

    Google Scholar 

  37. Levenson MJ, Michaels L, Parisier SC, Juarbe C. Congenital cholesteatomas in children: an embryologic correlation. Laryngoscope. 1988;98(9):949–55. https://doi.org/10.1288/00005537-198809000-00008.

    Article  PubMed  CAS  Google Scholar 

  38. Jackler RK. The surgical anatomy of cholesteatoma. Otolaryngol Clin North Am. 1989;22(5):883–96.

    Article  PubMed  CAS  Google Scholar 

  39. Gulya, A. J. Developmental anatomy of the ear. In Surgery of the ear, 4th edn., eds. Glasscock, M. E. & Shambaugh, G. E.. 1990; Philadelphia, PA: W. B. Saunders, pp. 5–33.

    Google Scholar 

  40. Bast TH, Anson BJ. The temporal bone and the ear. By Theodore H. Bast and Barry J. Anson. 1949. xviii + 478 pages, 165 figures. $12.00. Charles C. Thomas, Springfield, Illinois. Anat Rec. 1950;106:115–7. https://doi.org/10.1002/ar.1091060110.

    Article  Google Scholar 

  41. Caldas N, Caldas S. Acute otitis media. In: Costa SS, et al., editors. Otorhinolaryngology: principles and practice. Porto Alegre: Artes Médicas; 1994.

    Google Scholar 

  42. Misurya VK, Shrivastava PK. Functional eustachian tuboplasty: a new surgical technique. Arch Otolaryngol. 1976;102(6):330–3. https://doi.org/10.1001/archotol.1976.00780110042003.

    Article  PubMed  CAS  Google Scholar 

  43. Ross MA. Functional anatomy of the tensor palati. Its relevance in cleft palate surgery. Arch Otolaryngol. 1971;93(1):1–3passim. https://doi.org/10.1001/archotol.1971.00770060033001.

    Article  PubMed  CAS  Google Scholar 

  44. Sadé J. Middle ear and auditory tube: middle ear clearance, gas exchange, and pressure regulation. Otolaryngol Head Neck Surg. 1997;116:499–524.

    Article  PubMed  Google Scholar 

  45. Nagai T, Tono T. Encapsulated nerve corpuscles in the human tympanic membrane. Arch Otorhinolaryngol. 1989;246:169–72.

    Article  PubMed  CAS  Google Scholar 

  46. Ylikoski J, Panula P. Neuropeptides in the middle ear mucosa. ORL J Report Spec. 1988;50:176–82.

    CAS  Google Scholar 

  47. Cantekin EI, Doyle WJ, Reichert TJ, et al. Dilation of the eustachian tube by electrical stimulation of the mandibular nerve. Ann Otol Rhinol Laryngol. 1979;88:40–51.

    Article  PubMed  CAS  Google Scholar 

  48. Shupak A, Tabari R. Effects of middle ear oxygen and carbon dioxide tensions on eustachian tube ventilatory function. Laryngoscope. 1996;106:221–4.

    Article  PubMed  CAS  Google Scholar 

  49. Elner A. Normal gas change in human middle ear. Ann Otol Rhinol Laryngol. 1976;85:161–4.

    Article  PubMed  CAS  Google Scholar 

  50. Proctor B. The development of the middle ear spaces and their surgical significance. J Laryngol Otol. 1964;78:631–47.

    Article  PubMed  CAS  Google Scholar 

  51. Tos M. Epidemiology and natural history of secretory otitis. Am J Otol. 1984;5(6):459–62. PMID: 6542752.

    PubMed  CAS  Google Scholar 

  52. Williamson IG, et al. The natural history of otitis media with effusion—a three-year study of the incidence and prevalence of abnormal tympanograms in four South West Hampshire infant and first schools. J Laryngol Otol. 1994;108(11):930–4. https://doi.org/10.1017/s0022215100128567. PMID: 7829943.

    Article  PubMed  CAS  Google Scholar 

  53. Bluestone CD. Recent advances in the pathogenesis, diagnosis and management of otitis media. Pediatr Clin North Am. 1981;28(4):727–55.

    Article  PubMed  CAS  Google Scholar 

  54. Wilson NW, Hogan MB. Otitis media as a presenting complaint in childhood immunodeficiency diseases. Curr Allergy Asthma Rep. 2008;8(6):519–24. https://doi.org/10.1007/s11882-008-0095-6. PMID: 18940144.

    Article  PubMed  Google Scholar 

  55. Macintyre EA, Karr CJ, Koehoorn M, Demers P, Tamburic L, Lencar C, Brauer M. Otitis media incidence and risk factors in a population-based birth cohort. Paediatr Child Health. 2010;15(7):437–42. https://doi.org/10.1093/pch/15.7.437. PMID: 21886448; PMCID: PMC2948776

    Article  PubMed  PubMed Central  Google Scholar 

  56. Uhari M, Hietala J, Tuokko H. Risk of acute otitis media in relation to the viral etiology of infections in children. Clin Infect Dis. 1995;20(3):521–4.

    Article  PubMed  CAS  Google Scholar 

  57. Austeng ME, Akre H, Øverland B, Abdelnoor M, Falkenberg ES, Kværner KJ. Otitis media with effusion in children with in Down syndrome. Int J Pediatr Otorhinolaryngol. 2013;77(8):1329–32. https://doi.org/10.1016/j.ijporl.2013.05.027. Epub 2013 Jun 20. PMID: 23790958.

    Article  PubMed  Google Scholar 

  58. O’Reilly RC, Soundar S, Tonb D, Bolling L, Yoo E, Nadal T, Grindle C, Field E, He Z. The role of gastric pepsin in the inflammatory cascade of pediatric otitis media. JAMA Otolaryngol Head Neck Surg. 2015;141(4):350–7. https://doi.org/10.1001/jamaoto.2014.3581. PMID: 25633964.

    Article  PubMed  Google Scholar 

  59. Zhang Y, Xu M, Zhang J, Zeng L, Wang Y, Zheng QY. Risk factors for chronic and recurrent otitis media-a meta-analysis. PLoS One. 2014;9(1):e86397. https://doi.org/10.1371/journal.pone.0086397. PMID: 24466073; PMCID: PMC3900534.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  60. Tos M. Etiologic factors in secretory otitis. Adv Otorrhinolaryngol. 1988;40:57–64.

    CAS  Google Scholar 

  61. Wei WI. Serous otitis media in malignancies of the nasopharynx and maxilla. J Laryngol Otol. 1988;102(2):129–32.

    Article  PubMed  CAS  Google Scholar 

  62. Richardson MA. Upper airway complications of cigarette smoking. J Allergy Clin Immunol. 1988;81(5):1032–5.

    Article  PubMed  CAS  Google Scholar 

  63. Finkelstein Y, Ophir D, Talmi YP, et al. Adult-onset otitis media with effusion. Arch Otolaryngol Head Neck Surg. 1994;120:517–27.

    Article  PubMed  CAS  Google Scholar 

  64. Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M. Update on otitis media – prevention and treatment. Infect Drug Resist. 2014;7:15–24. https://doi.org/10.2147/IDR.S39637.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Hamd AA, Behiry EAEW, Atallah AT, et al. Effect of head and neck radiotherapy on the Eustachian tube functions. Egypt J Otolaryngol. 2020;36:39. https://doi.org/10.1186/s43163-020-00038-w.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Otolaryngology and Head and Neck Surgery, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Sady Selaimen da Costa

  2. Service of Otolaryngology and Head and Neck Surgery, Hospital de Clínicas, Porto Alegre, Rio Grande do Sul, Brazil

    Sady Selaimen da Costa

  3. Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery, São Paulo, SP, Brazil

    Sady Selaimen da Costa

  4. Brazilian Society of Otology, São Paulo, SP, Brazil

    Sady Selaimen da Costa

  5. International Hearing Foundation, Minneapolis, MN, USA

    Sady Selaimen da Costa

  6. International Advisory Board—American Academy of Otolaryngology and Head & Neck Surgery, Alexandria, VA, USA

    Sady Selaimen da Costa

  7. Collegium Oto-Rhino-Laryngologicum Amicitiae Sacrum, Helsinki, Finland

    Sady Selaimen da Costa

  8. Department of Otolaryngology, Head & Neck Surgery, University of Minnesota, Minneapolis, MN, USA

    Rafael da Costa Monsanto

Authors
  1. Sady Selaimen da Costa
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  2. Rafael da Costa Monsanto
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Editor information

Editors and Affiliations

  1. Department of Otolaryngology, Clínica Universidad de Los Andes, Santiago, Chile, USA

    Marcos V. Goycoolea

  2. Otolaryngology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Sady Selaimen da Costa

  3. Department of Otolaryngology, Tata Memorial Hospital, Mumbai, Maharashtra, India

    Chris de Souza

  4. Paparella Ear Head & Neck Institute, University of Minnesota, Minneapolis, MN, USA

    Michael M. Paparella

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da Costa, S.S., da Costa Monsanto, R. (2023). Otitis Media: Basic Concepts and Fundamentals. In: Goycoolea, M.V., Selaimen da Costa, S., de Souza, C., Paparella, M.M. (eds) Textbook of Otitis Media. Springer, Cham. https://doi.org/10.1007/978-3-031-40949-3_2

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