Acute Otitis Media

Question 1

What is acute otitis media (AOM)?

Answer 1

Inflammation of the middle ear, usually secondary to a bacterial infection spreading from the upper respiratory tract via the Eustachian tube; lasts fewer than 3 weeks.

Question 2

What is acute suppurative otitis media (ASOM)?

Answer 2

A complication of acute otitis media with perforation of the tympanic membrane and mucopurulent discharge.

Question 3

What is otitis media with effusion (OME)?

Answer 3

Presence of middle ear fluid without acute signs of infection; causes pain and hearing loss; related to recurrent inflammation and Eustachian tube dysfunction.

Question 4

What are common risk factors for acute otitis media in children?

Answer 4

Young age (peak in the first year), male gender, daycare attendance, lack of breastfeeding, exposure to tobacco smoke, craniofacial abnormalities, and immunocompromised status.

Question 5

What additional risk factors are associated with otitis media with effusion?

Answer 5

Atopy/asthma and chronic respiratory conditions such as Kartagener syndrome and cystic fibrosis.

Question 6

What are typical symptoms of otitis media in children?

Answer 6

Recent onset ear pain, fever, anorexia, vomiting, and aural fullness.

Question 7

How does the tympanic membrane appear in acute otitis media?

Answer 7

Red, bulging, and tender.

Question 8

What is a characteristic finding in acute suppurative otitis media?

Answer 8

Mucopurulent discharge due to tympanic membrane perforation.

Question 9

How does the tympanic membrane appear in otitis media with effusion?

Answer 9

Dull yellow or grey, retracted with loss of the cone of light reflex, and may have a visible fluid level behind it.

Question 10

What investigations are typically performed for otitis media?

Answer 10

Clinical diagnosis, ear swab for microbiology, and audiological assessment including pure tone audiometry and tympanometry.

Question 11

What is the usual duration of acute otitis media?

Answer 11

It is a self-limiting disease that typically lasts 3 days to 1 week.

Question 12

When are antibiotics indicated for acute otitis media in children?

Answer 12

If the child is systemically unwell, has signs of a more serious condition, is at high risk of complications, has otorrhoea, or is under 2 years old with bilateral acute otitis media.

Question 13

What is the first-line antibiotic treatment for acute otitis media?

Answer 13

Amoxicillin; for penicillin-allergic patients, clarithromycin or erythromycin may be used.

Question 14

What is the second-line antibiotic for worsening symptoms of acute otitis media?

Answer 14

Co-amoxiclav, especially if symptoms worsen or if the first-choice antibiotic has been taken for at least 2 to 3 days without improvement.

Question 15

Are decongestants or antihistamines effective in alleviating symptoms of acute otitis media?

Answer 15

No, they have not been shown to alleviate symptoms.

Question 16

What is the recommended management for otitis media with effusion otitis media with effusion?

Answer 16

Watchful waiting for 3 months with Valsalva manoeuvre to relieve symptoms; antibiotics, steroids, and decongestants have no benefit.

Question 17

When is surgical intervention indicated for otitis media with effusion?

Answer 17

If hearing loss persists for more than 3 months, there is language delay, craniofacial abnormalities, or a history of recurrent acute otitis media with OME; options include grommet insertion with or without adenoidectomy.

Question 18

What are potential complications of acute otitis media?

Answer 18

Acute mastoiditis, sensorineural and conductive hearing loss, cholesteatoma, facial nerve palsy, bacterial meningitis, neck and intracranial abscesses, and sigmoid sinus thrombosis.

Question 19

What is acute mastoiditis?

Answer 19

A rare complication of acute otitis media where infection spreads to the mastoid air cells, leading to abscess formation and potentially life-threatening sequelae.

Question 20

What are typical clinical findings in acute mastoiditis?

Answer 20

Post-auricular erythema, tenderness, swelling, fluctuance, proptosed auricle, and loss of the post-auricular sulcus.

Question 21

What is the typical age group affected by acute mastoiditis?

Answer 21

It is most common in children, with the highest incidence in those under 2 years old.

Question 22

What is the recommended management for acute mastoiditis?

Answer 22

Immediate hospital admission, intravenous antibiotics, and possible surgical intervention such as mastoidectomy.

Question 23

What is the role of tympanometry in assessing otitis media?

Answer 23

It measures middle ear pressure and compliance, aiding in the diagnosis of middle ear effusions.

Question 24

How can otitis media affect a child’s hearing?

Answer 24

It can cause conductive hearing loss due to fluid in the middle ear, and recurrent episodes may lead to more permanent hearing impairment.

Question 25

What preventive measures can reduce the risk of otitis media in children?

Answer 25

Breastfeeding, reducing exposure to tobacco smoke, managing allergies, and ensuring up-to-date vaccinations.

Question 26

What is the significance of a bulging tympanic membrane in otitis media?

Answer 26

It indicates increased middle ear pressure due to fluid accumulation, commonly seen in acute otitis media.

Question 27

How does otitis media with effusion differ from acute otitis media?

Answer 27

OME involves fluid in the middle ear without acute infection signs, while acute otitis media includes infection with rapid onset of symptoms.

Question 28

What is the purpose of grommet insertion in otitis media with effusion?

Answer 28

To ventilate the middle ear, allowing fluid drainage and improving hearing.

Question 29

Can otitis media lead to speech and language delays in children?

Answer 29

Yes, especially if it causes prolonged hearing loss during critical language development periods.

Question 30

What is the typical presentation of a child with otitis media?

Answer 30

Ear pain, irritability, fever, and sometimes ear discharge if the tympanic membrane has perforated.