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Infections of the upper respiratory tract are a common ambulatory care complaint, resulting in a large proportion of office visits. Although the vast majority of infections are viral and are self-limited, some may require hospitalization, particularly in the pediatric population. Bacterial etiologies of some of the common upper respiratory tract infections may be primary or superinfections of the original viral processes and are amenable to treatment (Table 75–1).

TABLE 75–1Common Infections of the Upper Respiratory Tract



Otitis media is an infection of the middle ear caused by either viruses or bacteria. Otitis media can be either acute or chronic. The information in this chapter refers to acute otitis media. Acute otitis media is the second most common diagnosis in children and the most common reason for prescribing antibiotics to a child.


Any process that leads to eustachian tube obstruction can result in fluid retention and concomitant infection of the middle ear. The most common predisposing factors are upper respiratory tract infections and seasonal allergic rhinitis. Otitis media is very common in children under the age of 3 years because they have a small opening of the eustachian tube that is easily blocked by the inflammation caused by a viral infection or an allergic response.

Clinical Manifestations

Patients present with ear pain (otalgia) and pressure, often accompanied by an upper respiratory tract infection. In infants, the ear pain may manifest as ear pulling. Patients may also complain of decreased hearing, irritability, poor sleeping, and fever. If the tympanic membrane ruptures, drainage from the ear may occur. On examination, the tympanic membrane is erythematous (Figure 75–1A and B) with a loss of the light reflex and decreased mobility. In some cases, the tympanic membrane may bulge and then rupture.


A: Normal tympanic membrane in a 6-year-old child. B: Otitis media in a 3-year-old child. Note bulging tympanic membrane and loss of light reflex. (Reproduced with permission from Tintinalli JE Stapczynski J, Ma OJ, et al: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th ed. New York, NY: McGraw Hill; 2009. ...

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