Acute Otitis Media (1)

Question 1

What is it?

What is its pathophysiology?

What are its causes?

Answer 1

➊ Infection and inflammation of the middle ear

➋ Viral URTI causes inflammation of respiratory mucosa → Obstruction of Eustachian tube → Negative middle ear pressure → Fluid accumulation → Microbial growth in fluid w/pus formation

➌ • Viral - RSV, other viral URTIs
• Bacterial - S. pneumoniae (most common), H. influenzae, M. catarrhalis

Question 2

How does it present?

What will be seen O/E?

Answer 2

➊ • Ear pain
• Reduced hearing
• Fever
• Usually preceded by a Viral URTI
• Otorrhoea if perforated tympanic

➋ • Bulging tympanic membrane
• Erythema
• Discharge

Question 3

Management:
What is the usual option here?

What can be given if the pt is systemically unwell or symptoms aren’t improving by itself?
→ How can it be prescribed?

Answer 3

➊ Most resolve within a wk w/o intervention, so they only require supportive management with simple analgesia (paracetamol/ibuprofen)

➋ Abx - Amoxicillin (1st line), Clarithromycin, Erythromycin
→ • Delayed - To take if pt isn’t improving or are getting worse
• Immediate - Given if pt is systemically unwell or at high risk of complications (e.g. immunocompromised)

N.B. Always safety-net the pt, making sure they know when to seek further medical attention

Question 4

Complications:
What are its extra-cranial complications (common)?

What are its intra-cranial complications (rare)?

Answer 4

➊ • Chronic Otitis Media
• Labrynthitis (HL+Vertigo) - Inflammation spreads to semi-circular canals, leading to vestibular dysfunction
• Mastoiditis - Infection spreads to form an abscess in the mastoid air spaces, leading to post-auricular swelling and mastoid tenderness
• Facial nerve palsy
• Petrositis - Infection spreads to apex of petrous temporal bone, leading to otorrhoea, retro-orbital pain, and ipsilateral CN6 palsy

➋ • Meningitis - presents with sepsis, headache, vomiting, photophobia and neck stiffness
• Sigmoid sinus thrombosis - presents with sepsis, swinging pyrexia and meningitis
• Brain abscess - presents with sepsis and neurological signs due to cranial nerve compression