Otitis media and acute bronchitis due to H. influenzae are generally caused by nontypeable strains. Hib strains account for only 5%–10% of H. influenzae causing otitis media.

The most common viruses detected in the MEF in these studies were RSV, influenza viruses, adenovirus, and parainfluenza viruses, i.e., the same viruses that had been identified in the nasopharyngeal specimens from children with AOM.

Pneumatic otoscopy is the standard of care in the diagnosis of acute and chronic otitis media. In AOM, the tympanic membrane normally demonstrates signs of inflammation, beginning with reddening of the mucosa and progressing to the formation of purulent middle ear effusion and poor tympanic mobility. The tympanic membrane may bulge in the posterior quadrants, and the superficial epithelial layer may exhibit a scalded appearance (see the image below).

Virulence

S. pneumoniae, H. influenzae, M. catarrhalis, group A beta-hemolytic streptococci and S. aureus (12, 18, 21–24, 63) (Table 1). The introduction of vaccination of children with the 7-valent pneumococcal vaccine in 2000 in the USA brought about a decline in the incidence of S. pneumoniae and an increase in H. influenzae in sinusitis