Acute otitis media

Question 1

What is acute otitis media?

Answer 1

Viral or bacterial infection of the middle ear that is most commonly caused by Streptococcus pneumoniae

Question 2

What is the epidemiology of acute otitis media?

Answer 2

Highest incidence between 6–24 months of age

Question 3

What are the causative organisms of acute otitis media?

Answer 3

S. pneumoniae (most common: 35% of cases)
Haemophilus influenzae (25% of cases)
Moraxella catarrhalis (15% of cases)

Question 4

What are the clinical features of otitis media?

Answer 4

(Infants) Irritability
Incessant crying
Refusal to feed 
Repeatedly touching the affected ear
Fever and febrile seizures
Tender mastoid in late stages
(Children) Otalgia/earache, commonly throbbing
Hearing loss in the affected ear
Fever
Tender mastoid in late stages

Question 5

How is otitis media diagnosed?

Answer 5

(Otoscaopy) Retracted and hypomobile tympanic membrane
Loss of light reflex
Red bulging TM with loss of landmarks
Yellow spot on TM 
(Tuning fork) Conductive hearing loss

Question 6

What is the treatment for acute otitis media?

Answer 6

Symptomatic pain management (paracetamol, ibuprofen)
(Antibiotics, if indicated i.e. bilateral + <2yrs) 5-day course of amoxicillin
(if allergic) erythromycin or clarithromycin