ENT - Otitis Media

Question 1

Definition

Answer 1

Infection of the middle ear - the space between the tympanic membrane and inner ear
- where the cochlear, vestibular apparatus and never are found

Question 2

Pathophysiology

Answer 2

Very common site of infection in children.
The bacteria enter from the back of the throat through the eustachian tube. A bacterial infection of the middle ear is often preceded by a viral upper respiratory tract infection

Question 3

Aetiology (Bacteria)

Answer 3

• Streptococcus pneumoniae (MC cause of ENT infections such as rhino-sinusitis and tonsillitis)
• Haemophillus influenzae
• Moraxella catarrhalis
• Staphylococcus aureus

Question 4

Signs and symptoms

Answer 4

Ear pain
Reduced hearing in the affected ear
General symptoms of upper airway infections
- fever
- cough
- coryzal symptoms
- sore thoat
- generally feeling unwell
When then infection affects the vestibular system it can cause balance issues and vertigo.
When the tympanic membrane has perforated there may be discharge from the ear.

Question 5

Non specific symptoms

Answer 5

Young child presenting with symptoms of fever, vomiting, irritability, lethargy or poor feeding

Question 6

Investigations

Answer 6

Examine both ears (otoscope) and throat using
- May be difficult to visualise if sig discharge or wax in ear canal
-normal = ‘pearly grey’, translucent and slightly shiny + be able to visualise the malleus through the membrane.
- otitis media = bulging, red, inflamed looking membrane, when performed will see discharge in ear canal and hole in tympanic membrane.

Question 7

Management

Answer 7

NICE guidelines = Do not provide Abx as most resolve within 3 days - 1 week.
Simple analgesia for pain and fever
Abx -
FIRST LINE = AMOXICILLIN for 5 days
SECOND LINE = CO-AMOXICLAV
Penicillin allergy: Macrolides e.g. ERYTHROMYCIN or CLARITHROMYCIN
Can be given:
- Immediate Abx:
= Px with sig co-morbidities, systemically unwell or are immunocompromised
= children under 2 with bilateral otitis media
= children with otorrhoea (discharge)
- Delayed prescription
= if symptoms don’t subside after 3 days + risk of getting worse
- No antibiotics

Question 8

Complications

Answer 8

Otitis medial with effusion
Hearing loss (usually temporary)
Perforated eardrum
Recurrent infection
Mastoiditis (rare)
Abscess (rare)

Question 9

Risk factor

Answer 9

Attendance at daycare
Bottle feeding: the absence of breast feeding
Family history
Craniofacial abnormalities
Gastroesophageal reflux disease