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Acute otitis media: the evolution of surgical management
1Department of Otolaryngology, University of Toronto, Hospital for Sick Children, ON.
Objective:
Acute suppurative otitis media has been a common disease since time immemorial and, until the late nineteenth century, was followed by a high complication rate, major morbidity, and frequent mortality. Since then, the overall incidence of the disease has changed little; however, in less than a century, progressively more sophisticated surgery and the introduction of antimicrobials have reduced the mortality, at least in developed countries, to a rarity. Complications such as chronic perforation of the tympanic membrane or cholesteatoma, although much less frequent than in the past, are not uncommon. The evolution of mastoid surgery into the antibiotic era is reviewed.
Conclusion:
There is concern that with the increasing frequency of bacterial resistance to antibiotics and the decreasing familiarity of family practitioners with the clinical presentation of complicated otitis media that we may be faced with a resurgence of mastoid disease.
Insights
Acute suppurative otitis media, while less deadly due to modern medicine, still presents complications. Growing antibiotic resistance and reduced clinician familiarity with complex cases may lead to a resurgence of mastoid disease.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Surgical History
Background:
- Acute suppurative otitis media (ASOM) historically led to high rates of complications, morbidity, and mortality.
- Advancements in surgery and antimicrobials have significantly decreased ASOM-related mortality in developed nations.
Observation:
- Despite reduced mortality, complications like chronic tympanic membrane perforation and cholesteatoma remain a concern.
- The evolution of mastoid surgery throughout the antibiotic era is a key focus.
Findings:
- While overall ASOM incidence is unchanged, sophisticated treatments have drastically lowered fatality rates.
- Mastoid surgery has transformed significantly with the advent of antibiotics.
Implications:
- Increasing bacterial resistance to antibiotics poses a threat to effective ASOM management.
- Decreased familiarity among practitioners with complicated otitis media may contribute to a potential resurgence of mastoid disease.