Acute Otitis Media

Question 1

What is AOM?

Answer 1

Inflammation of the ear due to infectious aetiology
Often affects young children

Causes
- Bacterial- haemophilus, strep.pneumonia, moraxella
- Viral- RSV, adenovirus

Question 2

What are clinical features of AOM?

Answer 2

Acute onset unilateral ear pain
- child may be suggest by ear tugging and irritability

Fever
Hearing loss
Recent viral URTI
Ear discharge if membranes perforates

Question 3

What is found on examination in AOM?

Answer 3

Tympanic membrane- erythematous, inflammed, loss of light reflex
- may have air fluid level if effusion

If perforation may be discharge in canal

Question 4

What is the management of AOM?

Answer 4

Should admit following to hospital
- severe systemic infection
- suspected complications of AOM
- children <3 months with fever >38
- consider admitting
– any patient <3 months
– 3-6 months with fever of 39 degrees or higher

Most patients do not require abx
- consider in
– systemically unwell
– <2 years with bilateral infection
– symptoms lasting >4 days without improvement
– immunocompromised
– perforation

Treat with Amoxicillin for 5-7 days
- if pen allergic clarithromycin or erythromycin
- consider coamox if worsening despite amox

Question 5

What is chronic suppurative otitis media?

Answer 5

Complication of AOM where there is chronic inflammation within the middle ear, resulting in recurrent otorrhoea through perforated tympanic membrane

Question 6

What are clinical features of CSOM?

Answer 6

Ottorhoea for >2 weeks often white/yellow/green
Conductive hearing loss
Sometimes tinnitus, aural fullness
No history of ear pain, fever or systemic illness

Question 7

What is found on investigation of CSOM? What is the management?

Answer 7

Perforated tympanic membrane
Dried discharge or debris in ear canal

Refer to ENT- management typically with aural toilet, topical abx and steroids

Question 8

What are features of mastoiditis?

Answer 8

Complication of AOM in which there is an extension of infection into mastoid air cells

Question 9

What are clinical features of mastoiditis?

Answer 9

Ear pain
Ottorhoea
Worsening hearing loss
Fever
Patient typically very unwell

Question 10

What is found on examination of mastoiditis?

Answer 10

Erythema, swelling and tenderness over mastoid process
External ear displaced forwards
Systemic upset
Otoscopy-discharge, bulging tympanic membrane