ACUTE OTITIS MEDIA: DIAGNOSIS AND TREATMENT IN ARMENIA
25 December 2025, Thursday
Acute otitis media (AOM) is an acute inflammatory condition of the mucosal lining of the tympanic cavity, primarily resulting from Eustachian tube dysfunction and infection. It is characterized by middle ear effusion and signs of acute inflammation. Duration: up to 3 weeks.
Etiology and Risk Factors
Pathogens (proven by culture and PCR):
- Bacteria: Streptococcus pneumoniae (~40%), Haemophilus influenzae (~30%), Moraxella catarrhalis (~10–15%)
- Viruses: RSV, influenza, parainfluenza, adenovirus, coronavirus, rhinovirus
Evidence-based risk factors:
- Age under 5 years (immature immunity, anatomical features of Eustachian tube)
- Formula feeding (lack of IgA and immune components of breast milk)
- Passive smoking (impairs mucociliary clearance)
- Adenoid hypertrophy (obstruction of Eustachian tube)
- Attending childcare (frequent respiratory infections)
- Genetic predisposition
- Barotrauma (aviation, diving)
- Immunodeficiency states
Classification
By duration:
- Acute: ≤3 weeks
- Subacute: 3–12 weeks
- Chronic: >12 weeks
By clinical type:
- Non-perforated
- Perforated with otorrhea
- AOM in the context of otitis media with effusion
By severity:
- Mild
- Moderate
- Severe (fever >39°C, pain >48 h)
Symptoms
Children:
- Ear pain
- Fever
- Irritability, poor sleep
- Hearing loss
- Otorrhea
Adults:
- Ear pain
- Fever (less common)
- Hearing loss
- Headache, fullness
- Balance disturbance (rare)
Diagnosis
Clinical diagnosis based on:
- Middle ear effusion (bulging tympanic membrane, reduced mobility)
- Signs of inflammation (erythema, fever)
- Additional: tympanometry, audiometry, CT/MRI if complications suspected
Treatment
1. Pain relief:
Paracetamol, ibuprofen
2. Antibiotic therapy (indications):
- Children <6 months
- Children 6–23 months with bilateral AOM
- Severe symptoms, otorrhea
- Adults with significant pain
- Course: 5–7 days (children >2 years, adults), 10 days (<2 years or complications)
3. Local treatment:
Otit drops with antibiotics (in otorrhea)
Complications
- Mastoiditis
- Tympanosclerosis
- Persistent perforation
- Sensorineural hearing loss
- Meningitis, brain abscess
- Facial nerve palsy
- Chronic otitis media
When to Consult a Physician
- Ear pain >2 days, fever >39°C
- Hearing loss >1 week
- Recurrent AOM (≥3 episodes in 6 months)
- Ear discharge
- Suspected complications (postauricular swelling, headache, neurological signs)
Tatevik Martirosyan, ENT doctor and pediatric doctor
Tatevik Martirosyan, ENT Specialist
Education
- Postgraduate studies, National Research Institute of Otorhinolaryngology, Moscow, Russia, 2017–2020
- Clinical Residency, National Research Institute of Otorhinolaryngology, Moscow, Russia, 2015–2017
- Medical degree, Pirogov Russian National Research Medical University, Russia, 2009–2015
Professional Experience
- ENT Specialist, Vardanants Innovative Medical Center, Yerevan, Armenia, 07.06.2024–28.11.2024
- Part-time ENT Specialist, Euromedservice Multidisciplinary Clinic, Moscow, Russia, 01.10.2023–01.02.2024
- ENT Specialist, IMMA Multidisciplinary Clinic, Moscow, Russia, 10.10.2022–01.02.2024
- ENT Specialist, ABC Medicine Multidisciplinary Clinic, Moscow, Russia, 10.01.2020–01.10.2022
- National Research Institute of Otorhinolaryngology named after L.I. Sverzhevsky, Moscow, Russia, 01.10.2018–01.12.2019
- Moscow Polyclinic No. 22, Branch No. 3, Russia, 01.09.2017–01.09.2018
Teaching Experience
- Clinical Practice, 4th-year students, National Research Institute of Otorhinolaryngology, Moscow, Russia, 2019
Academic Activities
- Ongoing Professional Development, Ministry of Health of Armenia, 11.01.2024–11.02.2024
- Qualification Upgrade in Otorhinolaryngology, Continuing Medical Education, Moscow, Russia, 18.01.2023–11.01.2024
- Advanced Training in "Emergency Otorhinolaryngology," Professional Development Academy, Moscow, Russia, 22.11–29.11.2021
- Advanced Training, Professional Development Academy, Moscow, Russia, 01.12–24.12.2020
Scientific Publications
- Published works in medical journals
- 3 patents
- "Method for assessing congenital immunity in patients with recurrent exudative otitis"
- "Endoscopic treatment of the auditory tube"
- "Silicone prosthesis for tympanic cavity formation"
- Methodological Contributions to Otorhinolaryngology:
- "Selection of methods to assist in stapedoplasty in patients with otosclerosis", 2020
- "Diagnosis and treatment of middle ear injuries in the outpatient setting", 2020
- "Otoscopy in emergency medical practice", 2018
- "Atypical middle ear inflammation: clinical features and diagnosis", 2018
- "Features of stapedoplasty in patients with tympanosclerosis", 2018
Awards
- Director's gratitude from the National Research Institute of Otorhinolaryngology for diligent work, professionalism, and sensitivity towards patients, 22.04.2019
- 2nd place diploma in the Young Otorhinolaryngologist Scientific Works Competition for the report "Syndrome of the patulous auditory tube and its treatment", 2019
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