Introduction: Rheumatoid arthritis is considered one of the most common, and particularly attacks the joint causing significant individual and community burden, and present with articular as well as extra articular manifestation. Treatment modalities of rheumatoid arthritis have dramatically improved in recent years, significantly decreasing long-term auricular and extra-auricular complications. Aim of the work: this review was aimed to study the pathophysiology, clinical picture, and management of rheumatoid arthritis, with focus on the newer modalities. Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1985, through February 2017. The following search terms were used: rheumatoid arthritis, chronic inflammatory disorders, genetic of rheumatoid arthritis, management of rheumatoid arthritis, DMARD, biological agents Conclusion: The newer modality of treatment must include disease-modifying antirheumatic drug (DMARDs) which must be started as early as possible. Combining DMARDs with corticosteroids will result in significantly better outcomes than monotherapy with any DMARD, and decrease long term morbidity associated with this condition.

Though often considered a disease of children, otitis media can affect the elderly. The incidence of otitis media among elderly population is variable among countries, but generally low, with a value ranging from 0.25-9%. However, dangerous complications may occur. Otitis media is a complex spectrum of diseases that include acute otitis media, otitis media with effusion, suppurative otitis media, and mastoiditis. Otitis media in elderly doesn’t feature the classical presentation in children. Elderly patients experience otalgia with or without hearing loss or signs of inflammation. Infection may spread to either to adjacent structures leading to mastoiditis, petrositis, labyrinthitis, or facial nerve palsy, or intracranially leading to meningitis, subarachnoid abscess, subdural abscess, encephalitis, brain abscess, lateral or sigmoid venous sinus thrombosis, and otitis hydrocephalus. The mainstay strategies for prevention of otitis media are the adequate proper treatment of each infection, and tight control of modifiable risk factors such as tobacco smoking, immunosuppression, upper respiratory tract infection, allergy, and craniofacial abnormalities. Antimicrobial treatment should be continued for at least 10-14 years.