Acute Otitis Media

Question 1

What is Acute Otitis Media?

Answer 1

Infection involving the middle ear space and is a common complication of viral respiratory illness

Question 2

What are the risk factors of Acute Otitis Media?

Answer 2

• Young age
• Older siblings
• Day care attendance
• Family History
• Absence of breastfeeding
• Lower socioeconomic status
• Immunological deficiency

Question 3

What are the potential causes of Acute Otitis Media?

Answer 3

• Viral
• Bacterial
• Mixed

Question 4

What is the most common causative organism?

Answer 4

Streptococcus Pneumoniae

Question 5

What are the clinical features of Acute Otitis Media?

Answer 5

• Otalgia
• Bulging tympanic membrane
• Myringitis
• Upper respiratory symptoms
• Fever
• Irritability
• Sleep disturbance

Question 6

What are the differential diagnosis of Acute Otitis Media?

Answer 6

• Otitis media with effusion
• Myringitis
• Mastoiditis
• Cholesteatoma

Question 7

What is Myringitis?

Answer 7

Erythema of the tympanic membrane. It is a type of AOM in which vesicles develop on the tympanic membrane

Question 8

What is Mastoiditis?

Answer 8

Bacterial infection of the mastoid air cells surrounding the inner and middle ear

Question 9

What is Cholesteatoma?

Answer 9

Abnormal, non-cancerous skin growth that can develop in the middle section of ear

Question 10

In what age group is Acute Otitis Media most prevalent?

Answer 10

Most common in children under the age of 2

Peak incidence between 6-18 months

Question 11

What is the pathophysiology of Acute Otitis Media?

Answer 11

• Upper respiratory pathogens impair the mucocilliary and ventilatory function of the Eustachian Tube
• Middle ear effusion develops, providing a good medium for bacterial growth
• Inflammatory process and formation of pus increases pressure against the tympanic membrane, leading to pain and fever
• In severe cases, tympanic membrane may perforate

Question 12

What are the investigations in suspected Acute Otitis Media?

Answer 12

=> Otoscopy
- Gold standard investigation, purulent middle ear effusion and bulging tympanic membrane can be seen

=> Bacterial culture

=> Tympanometry

=> Acoustic Reflectometry

Question 13

What is the management of Acute Otitis Media?

Answer 13

=> Oral or Rectal Analgesia
- Paracetamol or Ibuprofen

=> Start antibiotic therapy immediately if:

• symptoms lasting longer than 4 days or not resolving
• systematically unwell but not requiring admission
• immunocompromised or high risk of complications secondary to heart, lungs, kidney, liver or neuromuscular disorders
• younger than 2 years old with bacterial otitis media
• otitis media with perforation and/or discharge into canal

FIRST INE ANTIBIOTICS THERAPY => 5 day course of Amoxicillin. In patients with penicillin allergy, Erythromycin or Clarythromycin is used