Acute Otitis Media

Question 1

organisms

Answer 1

Streptococcus pneumonaie,

Haemophilus influenzae and

Moraxella catarrhalis

Question 2

features

Answer 2

otalgia
some children may tug or rub their ear
fever occurs in around 50% of cases
hearing loss
recent viral URTI symptoms are common (e.g. coryza)
ear discharge may occur if the tympanic membrane perforates

Question 3

otoscope findings

Answer 3

bulging tympanic membrane → loss of light reflex
opacification or erythema of the tympanic
membrane

perforation with purulent otorrhoea

decreased mobility if using a pneumatic otoscope

Question 4

Mx Abx plan - when to give

Answer 4

Symptoms lasting more than 4 days or not improving

Systemically unwell but not requiring admission

Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease

Younger than 2 years with bilateral otitis media

Otitis media with perforation and/or discharge in the canal

Question 5

Which Abx is usually given

Answer 5

Amoxicillin

5-7 days

Question 6

Which Abx if pen allergic

Answer 6

Erythromycin

Clarithromycin

Question 7

Complications

Answer 7

perforation of the tympanic membrane

hearing loss

labyrinthitis

mastoiditis

meningitis

brain abscess

facial nerve paralysis