Otitis media is Latin for inflammation and/or infection of the middle ear, the tiny area in between the ear drum and the inner ear.
When the middle ear becomes acutely infected, pressure from fluid builds up behind the eardrum (tympanic membrane), often causing fever and intense pain. This happens most frequently in young children who have small, relatively flat, eustachian tubes that are easily blocked with even small amounts of fluid. This susceptibility is inheritable, though the specific genetic markers are still under investigation. Casselbrant et al. recently found that the best-supported linkage regions may contain susceptibility genes that influence the risk for recurrent/persistent OM.
Just as an irrelevant point of interest, the most plausible candidates in 17q12 include AP2B1, CCL5, and a cluster of other CCL genes, and in 10q22.3, SFTPA2. Practically, otitis is frequently caused by viruses such as respiratory syncytial virus (RSV) and those that cause the common cold. The most common bacterial pathogen, and less frequent cause, is Streptococcus pneumoniae.
In recent years, there has been a subtle shift in the clinical practice of medicine. Physicians have been moving toward using evidence-based, patient-oriented outcomes data to guide their treatment and management of a variety of medical conditions. As a result of this shift, the treatment of acute otitis media has become more controversial. Discussion in the medical literature has centered on inappropriate use of antibiotics in the treatment of acute otitis media and upper respiratory tract infections. Current antibiotic usage patterns are thought to contribute to the increasing patterns of antimicrobial resistance in common pathogens of the middle ear. In response, the Centers for Disease Control and Prevention instituted a nationwide effort to address the problem of emerging infectious diseases and define patterns of antimicrobial resistance. At the moment, however, the choice to use antibiotics, or not, is still a clinical one.
Since the “causative infective agents” for Otitis are ubiquitous, for an infection to occur two things have to happen. First, there must be “fertile soil” for the infective organisms to live upon. Underlying allergies and the increased mucus production that they trigger can fulfill this first requirement. In children it’s not just inhaled allergens that can be a problem, but food allergies too. The second requirement is that of an immune system that isn’t paying attention. Nutritional deficiencies, stress and poor dietary choices are the most common causes. Biologically inappropriate doses of sugar, especially high fructose corn syrup, can divert the immune response. As little as the equivalent of one Snickers bar, can suppress the immune response for six hours.
Prevention, as usual, is the best course of action. Watch your vitamin D level (it’s probably low), take a good multivitamin, get plenty of sleep, eat your fruits and vegetables and avoid the junk.
Live long and prosper.
East End Wellness Center, Riverhead, N.Y.