https://ijmri.de/index.php/jmsi
volume 4, issue 7, 2025
463
ACUTE OTITIS MEDIA: THE MOST FREQUENT COMPLICATION OF
RHINOSINUSITIS IN YOUNG CHILDREN
Mamatova Shakhnoza Ramizidinovna
Kakhramonova Iroda Islom kizi
PhD Associate Professor Department of Otorhinolaryngology, Pediatric
Otorhinolaryngology,Tashkent Medical University, Uzbekistan
Student of the Faculty of Medicine at Kimyo International
University in Tashkent, Uzbekistan
Introduction.
Otitis media frequently arises as a secondary condition following acute respiratory
viral infections (ARVI). These infections often lead to mucosal swelling and inflammation of the
paranasal sinuses. According to epidemiological findings from the EPOS 2020 guidelines, the
global prevalence of viral-origin rhinosinusitis (ORSO) is estimated at 35–45%, depending on
the region. In children under 3 years of age, approximately 20 cases per 100 are documented
annually, increasing to 25 cases per 100 among adolescents aged 12 to 17.
Acute otitis media (AOM) remains one of the most widespread illnesses affecting both pediatric
and adult populations and is among the most frequent causes of antibiotic prescriptions—many
of which may be inappropriate. This review highlights current data on the prevalence of AOM in
Russian children and outlines the predominant viral and bacterial agents responsible. The term
"ototropic" refers to viruses with a greater propensity to induce AOM.
Keywords:
acute otitis media, rhinosinusitis, viral infection, diagnosis, treatment, young
children, complications
Острый отит: Наиболее частое осложнение риносинусита у детей
Вступление.
Средний отит часто возникает как вторичное заболевание после острых
респираторных вирусных инфекций (ОРВИ). Эти инфекции часто приводят к отеку
слизистой
оболочки
и
воспалению
придаточных
пазух
носа.
Согласно
эпидемиологическим данным, глобальная распространенность риносинусита вирусного
происхождения (ORSO) оценивается в 35-45%, в зависимости от региона. Ежегодно
регистрируется примерно 20 случаев на 100 детей в возрасте до 3 лет, а среди подростков
в возрасте от 12 до 17 лет этот показатель увеличивается до 25 случаев на 100. Острый
средний отит остается одним из наиболее распространенных заболеваний, поражающих
как детское, так и взрослое население, и является одной из наиболее частых причин
назначения антибиотиков, многие из которых могут оказаться неуместными. В этом
обзоре представлены современные данные о распространенности ОТ детей и описаны
основные вирусные и бактериальные возбудители, вызывающие данное заболевания.
https://ijmri.de/index.php/jmsi
volume 4, issue 7, 2025
464
Ключевые слова:
острый отит, риносинусит, вирусная инфекция, диагностика, лечение,
дети раннего возраста, осложнения
Anatomical Features of the Middle Ear in Young Children.
The anatomical characteristics of the middle ear in young children differ significantly from those
in adults, contributing to the increased incidence and severity of otitis media in this age
group:External Auditory Canal:
In infants, the external auditory canal is underdeveloped—short, narrow, and with the bony
portion represented only by the tympanic ring. As a result, pressure on the auricle during acute
otitis media can cause a sharp pain response and heightened distress in the child. Mastoid and
Facial Nerve Relationship:
In children with an underdeveloped mastoid process, the lower wall of the auditory canal
attaches to the styloid process, which lies almost horizontally and close to the descending branch
of the facial nerve. This anatomical proximity increases the risk of facial nerve paresis and
iatrogenic injury during procedures such as antrotomy. Tympanic Membrane and Paracentesis
Indications:
The tympanic membrane in young children is relatively thicker, round in shape, and positioned
nearly horizontally. Consequently, despite the accumulation of inflammatory exudate in the
tympanic cavity, visible bulging of the membrane may be absent—even when intoxication
symptoms progress. Pus may instead drain into the mastoid cavity through a wide aditus.
Therefore, the criteria for paracentesis in infants and young children are broadened and include:
a) sudden high fever,
b) severe otalgia,
c) pronounced systemic toxicity, particularly neurotoxicity,
d) emerging signs of facial nerve dysfunction.
In immunocompromised or weakened children, paracentesis should be performed without delay.
Tympanic Cavity Walls:
In children under one year of age, the walls of the tympanic cavity are thin and may contain
areas of dehiscence, allowing for rapid and unimpeded spread of infection.
Myxoid Tissue in the Middle Ear:
At birth, the middle ear is filled with embryonic myxoid tissue, which serves as a nutrient-rich
environment for microbial growth. This contributes to the high frequency of otitis media in
infants. Persistent myxoid tissue can lead to the formation of fibrous bands and partitions,
impairing drainage and potentially causing hearing loss.
Eustachian Tube Anatomy:
In early childhood, the pharyngeal opening of the Eustachian tube lies at the level of the hard
palate and posterior end of the inferior nasal concha, bordered posteriorly by a prominent
mucosal ridge. During adenoidectomy, this anatomical feature must be considered to avoid
scarring or stenosis of the Eustachian tube orifice, which could lead to conductive hearing loss.
Temporal Bone Fissures:
The petrous part of the temporal bone contains anatomical fissures that do not fully close until
approximately four years of age. Consequently, acute otitis media in young children can present
with severe symptoms that may mimic meningitis (meningism).
Mastoid Pneumatization:
The pneumatization of the mastoid process coincides with the replacement of diploic bone by
compact bone, a process that typically completes between the ages of 8 and 12. This corresponds
https://ijmri.de/index.php/jmsi
volume 4, issue 7, 2025
465
to the full development of the mastoid air cell system.
Complications:
One of the severe complications is otogenic sepsis, which is often caused by pathogens such as
Enterobacteriaceae and atypical hemolytic streptococcal strains. These microorganisms
frequently show poor sensitivity to commonly prescribed antibiotics, complicating treatment.
These clinical features are attributed to several anatomical characteristics of the pediatric ear. In
newborns, the tympanic membrane is relatively thicker than in adults due to a more prominent
fibrous layer and the properties of the embryonic mucosal tissue within the middle ear.
The most frequent complication of acute otitis media (AOM) is acute mastoiditis. Other
potentially severe complications include sinus thrombosis, otogenic meningitis, labyrinthitis,
facial nerve paralysis, and intracranial abscesses.
In the early stages of AOM—particularly during the eustachian or catarrhal phase—the primary
objective of therapy is the prevention of complications. Both conservative and surgical
approaches aim to restore the function of the Eustachian tube. To reestablish adequate ventilation
and drainage of the Eustachian tube, topical vasoconstrictors or astringent nasal drops are
commonly prescribed to reduce mucosal edema. Children should be encouraged to blow their
noses regularly, while in infants, nasal aspirators are used to remove secretions. For infants
specifically, vasoconstrictive nasal drops should be administered approximately 10 minutes
before feeding to prevent retrograde flow of nasal secretions into the Eustachian tube during
swallowing. Local therapy includes the use of analgesic and anti-inflammatory ear drops, such as
Otipax. Once the acute inflammatory process has subsided, otolaryngologists may recommend
additional procedures, including Eustachian tube inflation (via the Politzer method or
catheterization) and pneumatic massage of the tympanic membrane. At both the eustachian and
acute stages of otitis media, systemic analgesics, such as ibuprofen or paracetamol, are routinely
prescribed to manage pain and systemic symptoms.
Currently, no alternatives exist to antibiotic therapy (ABT) for treating acute bacterial otitis
media (AOM).
All infants under 6 months receive ABT upon suspected AOM, regardless of symptom
severity.
In children aged 6 months to 2 years, ABT is prescribed when the diagnosis is confirmed
or initiated within 72 hours if uncertain.
In children over 2 years, better symptom localization allows more selective use of ABT—
typically only for severe cases or when otorrhea is present. Up to 60% of cases in this age group,
especially those caused by Haemophilus influenzae
,
may resolve without antibiotics.
The decision to initiate ABT should weigh the risk of complications and potential for chronicity.
Intracranial complications (e.g., brain abscess, meningoencephalitis) carry a mortality rate of up
to 18.6%. Effective antibiotic therapy significantly reduces their incidence—from 2% to as low
as 0.04–0.15%. Studies show that 90% of mild AOM cases in children over 2 years resolve
without antibiotics, especially when caused by viruses or
H. influenzae
, and in the absence of
high fever (>38°C), severe pain, or systemic toxicity. If no improvement is seen within 24 hours,
ABT should be started promptly.
The treatment of acute otitis media (AOM) depends on the stage of the disease, dominant
symptoms, and the patient’s overall health. Given that the Eustachian tube is the primary route of
infection, therapy should focus on nasopharyngeal and nasal decongestion. Swelling of the nasal
and nasopharyngeal mucosa—especially near the Eustachian tube orifice—impairs ventilation
https://ijmri.de/index.php/jmsi
volume 4, issue 7, 2025
466
and drainage of the middle ear, making vasoconstrictor nasal drops a key component of
symptomatic care. Although many topical agents are available, local antibacterial drops do not
replace systemic antibiotic therapy. For purulent AOM, antibiotics with proven in vitro efficacy
against common pathogens are required. However, persistent symptoms occur in ~28% of cases,
with high failure rates noted for co-trimoxazole (75%), amoxicillin (57%), cefaclor (37%), and
cefixime (23%). The most effective agents are amoxicillin/clavulanate and azithromycin.
Amoxicillin and amoxicillin/clavulanate are preferred oral drugs, meeting key efficacy criteria.
According to the AAP, children over 2 years with uncomplicated AOM do not benefit more from
a 5-day vs. 10-day amoxicillin course. In contrast, children under 2 or those with tympanic
membrane perforation should receive a 10-day course. High-dose amoxicillin (80–90 mg/kg/day)
is recommended in cases with risk factors for resistant pathogens. Russian guidelines note that
amoxicillin remains the most active oral β-lactam against penicillin-resistant
Streptococcus
pneumoniae
among available penicillins and cephalosporins.
This issue is particularly relevant for children under three years of age. At the outpatient stage,
treatment response should be assessed within 24 hours of the initial visit. If an otolaryngologist is
unavailable during this period, a decision must be made regarding either hospitalization or daily
pediatric supervision.Given these factors, this study aims to investigate the clinical
characteristics and developmental aspects of acute and recurrent purulent otitis media in early
childhood.
Materials and Methods:
The study analyzed medical records of 83 children, aged 1 to 3 years, hospitalized for acute or
recurrent otitis media in the ENT department of TashPMI Clinic during 2022–2023. Data were
assessed based on age, sex, and clinical presentation. Among these patients, 55 were boys and 28
were girls, yielding a male-to-female ratio of 2:1. The investigation revealed that catarrhal
symptoms were common among the affected children: nasal congestion was observed in 80
patients (96%), mucous nasal discharge in 75 patients (90%), redness of the posterior pharyngeal
wall in 25 patients (30%), cough in 54 patients (65%), and fever in 62 patients (74%). Several
children showed signs of intoxication, including lethargy, decreased appetite, sweating, and
disturbances in sleep patterns. A temperature response was recorded in all children participating
in the study. Clinical manifestations of conjunctivitis were noted in 28% of the children, while
orbital complications occurred in 2%, and sinus thrombosis was present in 0.1% of cases.
The clinical presentation of ear diseases in young children typically enables general practitioners
to make an accurate diagnosis and determine the appropriate management for the patient.
Moreover, given the risk of serious intracranial complications arising from otogenic infections,
prompt treatment of acute otitis media is critical and can be life-saving. In light of the
widespread shortage of specialized pediatric otolaryngology services, the initial responsibility for
assessing a sick child often rests with the pediatrician. This article reviews the current
classification of acute otitis media, the key morphofunctional factors contributing to its
development in children, the clinical features, diagnostic approaches, and primary treatment
protocols for acute middle ear disease in the pediatric population. Acute otitis media should be
understood as an inflammatory condition affecting the mucosal lining of the air-filled cavities of
the middle ear. Importantly, this pathology is not confined to the tympanic cavity alone but
involves, to varying degrees, all cavities within the temporal bone.
Conclusions:
https://ijmri.de/index.php/jmsi
volume 4, issue 7, 2025
467
The often latent course and nonspecific symptoms of acute otitis media frequently delay timely
otolaryngologist evaluation, especially in cases lacking classical signs such as fever, ear pain, or
purulent discharge.Pain assessment depends on the child’s individual tolerance; therefore, careful
observation and correlation with parental reports are essential to obtain an accurate clinical
picture.Parental history is valuable—for instance, a child who cries during breastfeeding but not
spoon-feeding may indicate ear involvement. Additional signs include crying during sleep, ear
pulling, head rubbing, and increased distress upon tragus pressure. Otoscopy alone may be
inconclusive, as tympanic membrane hyperemia can result from crying rather than infection, and
purulent exudate may be absent due to drainage via a wide Eustachian tube.
References:
1.Mamatova, Sh., Karabayev, Kh., & Namakhanov, A. (2023). Ultrasonographic Examination of
Rhinosinusitis in Early Childhood. Journal of Biomedicine and Practice, 1(2), 63–69.
https://doi.org/10.26739/2181-9300-2021-2-10
2. Mamatova, Sh. R., Karabayev, Kh. E., & Ismatova, K. A. (2022). Current Issues in
Diagnosing Acute Rhinosinusitis in Early Childhood Bronchopulmonary Pathology. In Problems
of Post-COVID Otorhinolaryngology.
3. Mamatova, Sh. R., Karabayev, Kh. E., & Agzamkhodzhaeva, N. Sh. (2021). Features of
Diagnosing Acute Rhinosinusitis Against the Background of Bronchopulmonary Pathology in
Early
Childhood.
Re-health
Journal,
(2)10.
Retrieved
from
https://cyberleninka.ru/article/n/osobennosti-diagnostiki-ostrogo-rinosinusita-na-fone-
bronholegochnoy-patologii-u-detey-rannego-vozrasta (accessed March 19, 2025).
4.Mamatova, Sh., Nizamova, E., Ismatova, K., & Kakhramonova, I. (2023). Issues of Diagnosis
and Treatment of Rhinosinusitis in Early Childhood Patients. Pediatrics, 1(1), 151–154.
Retrieved from https://inlibrary.uz/index.php/pediatrics/article/view/26653
5.Mamatova, S., Karabaev , X. ., & Asqarov , M. . (2024). STUDY OF CLINICAL AND
DIAGNOSTIC FEATURES OF ORBITAL BASES OF RHINOSINUSITIS IN EARLY
CHILDREN. Development of Pedagogical Technologies in Modern Sciences, 3(6), 201–204.
Retrieved from https://www.econferences.ru/index.php/dptms/article/view/15510
6. Mamatova S. R. et al. DETERMINATION OF MICROORGANISMS MARKERS BY THE
METHOD GC-MS AND EFFICACY EVALUATION OF RHINOSINUSITIS //Science and
innovation in the education system. - 2023. - T. 2. – no. 2. - S. 13-15.
7. Garashchenko T.I., Kozlov R.S. Acute otitis media in children. Prejudices of pharmacotherapy.
Pediatric otorhinolaryngology. 2013; 3:31–6. [in Russian]
8. Karpova E.P., Belov V.A., Asmanov A.I. Validity of local anesthetic therapy in the treatment
of acute otitis media in children. RMJ. Mother and child. 2023;6(4):411-416. DOI:
10.32364/2618-8430-2023-6-4-14 [in Russian]
9. Nussinovitch M, Yoeli R, Elishkevitz K, Varsano I. Acute mastoiditis in children:
epidemiologic, clinical, microbiologic, and therapeutic aspects over past years. Clinical
Pediatrics, 2004, 43(3): 261-7. doi 10.1177/000992280404300307.
10. Zyryanova K.S., Dubinets I.D., Ershova I.D., Korkmazov M.Yu. Initial therapy for acute
otitis media in children. Doctor. 2016; 1:43–5. [in Russian]
11. Karneeva O.V., Polyakov D.P. A modern approach to the treatment of diseases of the upper
respiratory tract and middle ear as a measure for the prevention of hearing loss. Pediatric
pharmacology. 2012; 9 (1): 30–4. [in Russian]
12. Siegel RM, Kicly M, Bien JP et al. Treatment of otitis media with obstruction and safety net
antibiotic prescription. Pediatrics 2003; 112: 527–31. 13. Greenberg D, Hoffman S, Leibovitz E,
Dagan R. Acute otitis media in children: association with day care centers – antibacterial
resistance, treatment, and prevention. Pediatric Drugs 2008; 10(2):75–83.
https://ijmri.de/index.php/jmsi
volume 4, issue 7, 2025
468
13. Venekamp RP, Sanders S, Glasziou PP et al. Antibiotics for acute otitis media in children
Cochrane Acute Respiratory Infections Group 2013. DOI: 10.1002/14651858.CD000219.pub3
15. [in Russian]
14. 14. Klein D. Therapy of acute otitis media in the era of changing sensitivity to antibacterial
drugs. MSRPA News. 1999; 2:46./ [in Russian]
15. Smith NSP. Antibiotic treatment for acute otitis media. Int J Pediatr Otol 2013; 77. Is. 5:
873–4.
16.. Karabaev, H. E., and Sh. R. Mamatova. "Clinical case of orbital complications in
rhinosinusitis in young children." Eurasian Bulletin 3 (2020): 78-82.
