Acute Otitis Media

Question 1

Define

Answer 1

Young eustachian tubes are short, horizontal and function poorly -> middle ear infection

o Very common; most 6-12 months (most children have 1 episode)

o RFs: FHx, male gender, cleft palate, Down’s syndrome

o Causative organism = H. influenza, S. pneumoniae, RSV

Question 2

Sings and symptoms / Ix

Answer 2

Signs & symptoms:
- Pain in the ear and fever

Investigations:
- Temperature
- Otoscopy -> bright red bulging tympanic membranes, loss of normal light reaction, perforation and pus

Question 3

Management

Answer 3

N.B. ABx marginally reduce duration of pain but no effect on risk of hearing loss

Admit if:
- Severe systemic infection
- Complications (e.g. meningitis, mastoiditis, facial nerve palsy)
- Children <3 months with a temperature >38 degrees

Acute otitis media:

• Advice (otitis media without effusion):
• Acute otitis media lasts about 3 days (up to 1 week) – most recover without ABx
• Use regular ibuprofen/paracetamol
• No evidence to support the use of decongestants or antihistamines

Medical Management:

· Antibiotic regimen:

• No antibiotic prescription – most cases will resolve spontaneously à seek help if symptoms haven’t improved after 3 days or if the child deteriorates clinically
• Delayed antibiotic prescription –antibiotics NOT needed immediately but should be used if symptoms not improved after 3 days or if worsened greatly at any time
• Immediate antibiotic prescription – systemically unwell, age <2yo

· Antibiotics of choice:

• 1st line = amoxicillin, 5 days penicillin allergy: clarithromycin, erythromycin

Question 4

Acute otitis media with perforation Mx

Answer 4

Oral amoxicillin, 5 days

• Review in 6 weeks to ensure healing

Question 5

Acute otitis media with effusion

Answer 5

Signs & symptoms = asymptomatic except for possible reduced hearing (conductive hearing loss)

• Can interfere with normal speech development à learning difficultie
• Otoscopy = eardrum is dull and retracted, often with a fluid level visible

Investigations:
- Tympanometry
- Audiometry

Management:
Co-existent cleft palate or Down’s syndrome or other* à refer to ENT
- Hearing loss, structurally abnormal tympanic membrane, cholesteatoma discharge

No co-morbidities à active observation for 6-12 weeks:
- 1) Two hearing tests (pure tone audiometry), 3 months apart
- 2) If persistent past 6-12 weeks, refer to ENT
- Non-surgical – hearing aids, active monitor for 3m, auto-inflation
- Surgical – myringotomy and grommets
- Benefits do NOT last longer than 12 months
- Problems after extrusion of grommet à reinsertion of grommets

· SEs: otorrhoea > cholesteatoma, bleeding, tympanosclerosis

Question 6

Complications

Answer 6

Perforation

o Mastoiditis (chronic OM à honeycomb structure behind ear inflamed à discharge + swelling behind ear)

o Meningitis

o Facial nerve palsies

o Febrile convulsions