Acute Otitis Media and OME

Question 1

Acute Otitis Media RF, Ex and Ax?

Answer 1

Ex: Most common at 6-12 months of age

Ax: Commonly viral e.g. RSV or rhinovirus
Bacterial: H.influenzae or Moraxella Catarrhalis

RF: Infants and young children more prone due to short, horizontal Eustachian tube - functions poorly

Question 2

Pathophys of Acute Otitis Media?

Answer 2

Organisms reach the middle ear from the nasopharynx and in young children the Eustachian tube is short and horizontal - when it remains open infected material can be transmitted to the middle ear. As they age - tube angle becomes more acute - when they cough/sneeze the tube is forced shut thereby minimising infection transmission.

Question 3

Clinical presentation of Acute Otitis Media?

Answer 3

1) Pain in the ear

2) Fever: Any child with fever must have tympanic membrane checked.

Question 4

Ddx of Acute Otitis Media?

Answer 4

Foreign body in external canal, trauma, RTI, radiating pain from teeth.

Question 5

Diagnosis of Acute Otitis Media?

Answer 5

1) Tympanic membrane is bright red and bulging, with loss of normal reflective light reflex.
2) Occasionally there is acute perforation of the eardrum with pus visible.

Question 6

Treatment of Acute Otitis Media?

Answer 6

1) Analgesic: Paracetamol/Ibuprofen
2) Majority of cases self-resolve
3) Antibiotics - if prolonged (2-3 days) give amoxicillin (reduces pain but not risk of hearing loss)

Question 7

Complications of Acute Otitis Media?

Answer 7

Rare but mastoiditis/meningitis

Question 8

Otitis Media with Effusion (OME)/Glue ear Ex and PPx:

Answer 8

• Recurrent ear infections can lead to OME/glue ear.
• Most common between 2-7 years, commonest cause of conductive hearing loss in children.

PPx: Build up of glue-like fluid in the middle ear due to inadequate Eustachian tube drainage resulting in conductive hearing loss.

Question 9

Presentation of OME?

Answer 9

1) Asymptomatic apart from decreased hearing

2) Can interfere with normal speech development and learning difficulties at school.

Question 10

Diagnosis of OME?

Answer 10

1) Eardrum dull and retracted with fluid level visible.

2) Tympanometry (flat trace) and evidence of conductive hearing loss on pure tone audiometry (if >4 years) - DIAGNOSTIC

Question 11

Treatment of OME?

Answer 11

1) Resolves spontaneously
2) Grommets tube extrusion - fluid drainage
3) If recurrent after Grommets extrusion - Grommets should be reinserted with adenoidectomy (adenoids can interfere with tube drainage).