ENT - Otitis Media Flashcards
What is otitis media?
Middle ear infection
How do throat infections lead to otitis media?
Bacteria enter via eustachian tube
Bacterial infection often preceded by viral URTI
What are the most common bacterial causes of otitis media?
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
How does otitis media present?
Ear pain
Reduced hearing
URTI symptoms
Symptoms can be very non-specific e.g.
Fever
Vomiting
Irritability
Lethargy
Poor feeding
If the vestibular system has been affected what symptoms might a patient have?
Balance issues
Vertigo
If the tympanic membrane has been perforated what can occur?
Ear discharge
When examining the ear how should an otoscope be used?
Gently pull the pinna up and backwards
What is the normal appearance of the tympanic membrane?
Pearly-grey
Translucent
Slightly shiny
Able to visualise malleus through membrane and cone of light
How is otitis media managed?
Paediatric referral
Always refer if under 3 months and temperature over 38
Or
3-6 months and temperature over 39
Always safety-net when to seek further medical attention
How does otitis media appear on examination?
Bulging, red, inflamed tympanic membrane
If there is perforation may see discharge
How are antibiotics prescribed to patients with otitis media?
Immediate antibiotics
Delayed prescription
None given
When should antibiotics be prescribed at initial presentation?
Systemically unwell
Immunocompromised
Under 2 with bilateral otitis media
Otorrhoea
When should a delayed prescription be collected?
After 3 days if symptoms have not improved or worsened at any time
What antibiotics are used for otitis media?
Amoxicillin for 5 days
Erythromycin or clarithromycin if allergic
What are the potential complications of otitis media?
Otitis media with effusion
Hearing loss (temporary)
Perforated eardrum
Recurrent infection
Mastoiditis (rare)
Abscess (rare)
What is another name for otitis media with effusion?
Glue ear
What happens in glue ear?
Middle ear becomes full of fluid causing hearing loss
What causes otitis media with effusion?
Eustachian tube drains secretions from middle ear
When blocked, this causes middle ear secretions to build up causing glue ear
What is the main complication of otitis media with effusion?
Infection, otitis media
What does otoscopy in glue ear show?
Dull tympanic membrane
Air bubbles or visible fluid level
Can also look normal
How is otitis media with effusion managed?
Audiometry referral
Conservative treatment
How long does otitis media with effusion take to resolve usually?
Within 3 months
When might a child require hearing aids or grommets?
Co-morbidities affecting ear structure e.g. Down’s syndrome or cleft palate
What do grommets do?
Allow fluid from middle ear to drain through tympanic membrane to ear canal
Usually inserted under general anaesthetic as a day case
How long are grommets used for?
Usually fall out within a year
1/3 patients may need to be reinserted for persistent glue ear
