ENT

Question 1

What is otitis media?

Answer 1

Infection and inflammation of the middle ear

Question 2

When does otitis media typically present?

Answer 2

Paediatric presentation post URTI

Question 3

What is the most common cause of acute otitis media in children?

Answer 3

Strep pneumoniae (pneumococcus)

Question 4

What are some of the bacterial causes of otitis media?

Answer 4

1) Streptococcus pneumoniae
2) Haemophilus influenzae
3) Moraxella catarrhalis

Question 5

What are some of the viral causes of otitis media (either by causing the infection directly or by predisposing the ear to bacterial infection)?

Answer 5

1) Respiratory syncytial virus (RSV)
2) Rhinovirus
3) Influenza virus
4) Adenovirus

Question 6

How does otitis media present?

Answer 6

Rapid onset:
1) Deep seated pain
2) Impaired hearing
3) Aural fullness
4) Systemic illness/fever
5) Irritability
6) Anorexia
7) Vomiting
8) Discharge with tympanic membrane perforation

Question 7

What are potential complications of otitis media?

Answer 7

1) LMN facial nerve palsy
2) Mastoiditis
3) Petrositis - infection spreading to the apex of the petrous temporal bone
4) Labyrinthitis - inflammation of the semicircular canals leading to the symptoms of vertigo, nausea, vomiting and imbalance

Question 8

How do you diagnose otitis media?

Answer 8

Otoscopy

Question 9

What would you see on otoscopy of otitis media?

Answer 9

1) Tympanic membrane shows injection of blood vessels
2) Diffuse erythema

Question 10

How do you manage acute otitis media?

Answer 10

1) Hospital admission
2) Analgesia and antipyretics - most children
3) Abx - systemically unwell, high probability of complications e.g. immunocompromised

Question 11

When would you admit to hospital for otitis media?

Answer 11

1) Children < 3 months with temp > 38
2) Children with suspected acute complications
3) Consider if very systemically unwell