Acute Otitis Media ( Middle Ear Infection )

Question 1

What it acute otitis media ?

Answer 1

Acute otitis media can be described as inflammation associated with effusion (accumulation of fluid within the middle ear without the sign of an infection) and a rapid onset of symptoms, with signs of infection.

Question 2

Causes of Acute Otitis Media

Answer 2

Acute otitis media often occurs after an upper respiratory tract infection. Eg. a cold

This infection can lead to swelling of the lining of the nose, throat and Eustachian tube. The swelling of the Eustachian tube blocks the drainage of fluid from the middle of the ear causing fluid and pressure build up behind the ear drum. The congested fluid can become infected with viruses or bacteria or frequently both.

Question 3

Presenting Symptoms

Answer 3

Earache

Partial loss of hearing

Possible fever

Discharge which may contain pus

Young children may hold, rub or tug at their ear. They may also present with non-specific symptoms such as crying, poor feeding, restlessness or a cough

The tympanic membrane may be perforated with or without discharge.

Otitis media occurs most frequently in children but can occur in adults. It is most common in babies and children up to the ages of 14 years.

Question 4

Risk factors associated with the development of acute otitis media

Answer 4

Exposure to smoking

Exposure to viruses. Eg. children attended nursery or daycare.

Formula fed babies

Use of a dummy

Acute otitis media occurs more frequently in winter.

Question 5

Use of antibiotics

Answer 5

Antibiotics make very little difference and are not requires in most patients.

However antibiotics should be considered for those patients who:

Have discharge due to perforated ear drum

Are younger than 2 yrs old and have an infection in both ears

Are systemically very unwell or at risk of complications

Applicable antibiotics -

Amoxicillin for 5-7 days

In cases of penicillin allergy, clarithromycin or erythromycin.

Question 6

Typical management

Answer 6

Watchful waiting and an analgesic

In children and young people under 18 yrs old, ear drops containing an analgesic and anaesthetic can be prescribed if appropriate.

A backup rx for antibiotics may be supplied with advice not to dispense unless :

Symptoms worsen suddenly or significantly

Do not improve after 3 days

The patient becomes systemically unwell.

Question 7

Safety netting

Answer 7

Symptoms worsen suddenly or significantly

Symptoms do not improve within the expected time frame

The patient becomes systemically unwell

Question 8

Red Flag Management

Answer 8

Referrals should me made if :

Have a systemic infection

Have suspected complications

Are younger than 3 months with a temp of 38degrees or higher.