[Acute otitis media with effusion: an overview of the pathogenesis and recommendations for therapy]

Otitis media is one of the most common diseases in infants and young children. A combination of important factors contributes to the pathogenesis of acute otitis media and otitis media with effusion. These are poor tubal function, the degree of mastoid pneumatization, nasopharyngeal colonization with pathogenic bacteria and viruses, the ascending infectious pathway along the Eustachian tube, the immune status of the host, allergic and environmental factors, and genetic predisposition. Only correct diagnosis and understanding of they underlying pathophysiology enables the clinician to target treatment of the various forms of otitis media. We review the current concepts regarding evaluation and management of the diseased child and focus on the indication and selection of antibiotic therapy, bearing in mind the resistance rate within Switzerland. Most patients can be treated medically. "Otitis prone" individuals and children suffering from chronic otitis media with effusion with documented hearing loss clearly benefit from surgical intervention. We analyze the different treatment modalities and present a step-wise treatment algorithm. Newer vaccination trials indicate immunogenic effects even in young infants and show promising results in experimental and clinical studies.