Acute Otitis Media

Question 1

What is Otitis Media?

Answer 1

Infection of the middle ear (between tympanic membrane and the inner ear) - site of cochlea, vestibular apparatus and nerves.

Question 2

Aetiology of Bacterial Otitis Media.

Answer 2

Bacteria enter from throat via Eustachian tube after an URTI disturbs the normal nasopharyngeal microbiome.

Question 3

Bacterial Causes of Otitis Media.

Answer 3

1. S. pneumonia (commonest in Otitis Media, Rhinosinusitis, Tonsillitis).
2. H. influenza.
3. M. catarrhalis.
4. S. aureus.

Question 4

Clinical Presentation of Otitis Media (6).

Answer 4

1. Otalgia (Ear Pain).
2. Reduced Hearing in Affected Ear.
3. Feeling Unwell e.g. Fever.
4. Preceding Viral URTI e.g. Cough, Coryzal Symptoms, Sore Throat.
5. If Vestibular System is Affected : Balance Issues and Vertigo.
6. If Perforated Tympanic Membrane : Discharge.

Question 5

Otoscopy Results in Otitis Media (2).

Answer 5

1. Normal Tympanic Membrane : Pearly Grey, Translucent and Slightly Shiny.
2. Otitis Media : Bulging, Red, Inflamed Membrane (with/out discharge) - Loss of Light Reflex.

Question 6

Diagnostic Criteria of Otitis Media (3).

Answer 6

1. Acute Onset - Otalgia/Ear Tugging (Kids).
2. Presence of Middle Ear Effusion (Bulging Membrane, Otorrhoea, Decreased Mobility on Pneumatic Otoscopy).
3. Inflammation of Tympanic Membrane.

Question 7

Management of Otitis Media.

Answer 7

1. Simple Analgesia.

2. ? Antibiotics ?

Question 8

Antibiotic Prescription Options.

Answer 8

1. Immediate Antibiotics.
2. Delayed Prescription.
3. No Antibiotics.

Question 9

Indications of Immediate Antibiotics in Otitis Media (3).

Answer 9

1. Immunocompromised.
2. Systemically Unwell.
3. Significant Co-Morbidities.
4. Lasting 4+ Days/Not Improving.
5. Age <2 and Bilateral.
6. With Perforation and/or Discharge.
7. Age < 3 Months.

Question 10

When is a Delayed Prescription useful?

Answer 10

Can be collected and used after 3 days if symptoms don’t improve or worsen - if patents really want antibiotics.

Question 11

Which Antibiotics are prescribed? (3)

Answer 11

1. Amoxicillin 5-7 Days.
2. Clarithromycin (Penicillin Allergy).
3. Erythromycin (Pregnancy - Penicillin Allergy).

Question 12

Prognosis of Otitis Media.

Answer 12

1. Resolve without antibiotics within 3 days.

Question 13

Complications of Otitis Media.

Answer 13

1. Mastoiditis (Rare).
2. Otitis Media with Effusion.
3. Hearing Loss + Perforated Tympanic Membrane.
4. Labyrinthitis (Dizziness/Vertigo).
5. Abscess (Rare).
6. Facial Nerve Palsy (Rare).
7. Meningitis (Rare)

Question 14

Clinical Presentation of Mastoiditis and Management (4+1).

Answer 14

1. Tenderness of Mastoid.
2. Lateral and Inferior Displacement of Pinna.
3. Thick Purulent Discharge.
4. Risk Factor in Adults : Diabetes.
5. CT SCAN!

Question 15

What is Glue Ear?

Answer 15

Otitis Media with an Effusion (Serous Otitis Media).

Question 16

Risk Factors of Glue Ear (4).

Answer 16

1. Male Kid.
2. Family History.
3. Winter/Spring.
4. Bottle Feeding, Day-Care, Parental Smoking.

Question 17

Clinical Presentation of Glue Ear.

Answer 17

1. Peak : 2 Years.
2. Commonest Feature : Hearing Loss - commonest cause of conductive hearing loss in kids).
3. Speech and Language Delay, Behavioural/Balance Problems.

Question 18

What are Grommets?

Answer 18

Thin tubes that sit in the ear drum allowing fluid to pass from behind the ear drum to be discharged (function of Eustachian tube).

Question 19

Indication of Grommets.

Answer 19

Recurrent Episodes of Otitis Media.

2. If Inserting twice - indication : Tonsilloadenelectomy.