ENT - Otitis Media

Question 1

What is otitis media?

Answer 1

Middle ear infection

Question 2

How do throat infections lead to otitis media?

Answer 2

Bacteria enter via eustachian tube

Bacterial infection often preceded by viral URTI

Question 3

What are the most common bacterial causes of otitis media?

Answer 3

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus

Question 4

How does otitis media present?

Answer 4

Ear pain
Reduced hearing
URTI symptoms

Symptoms can be very non-specific e.g.
Fever
Vomiting
Irritability
Lethargy
Poor feeding

Question 5

If the vestibular system has been affected what symptoms might a patient have?

Answer 5

Balance issues
Vertigo

Question 6

If the tympanic membrane has been perforated what can occur?

Answer 6

Ear discharge

Question 7

When examining the ear how should an otoscope be used?

Answer 7

Gently pull the pinna up and backwards

Question 8

What is the normal appearance of the tympanic membrane?

Answer 8

Pearly-grey
Translucent
Slightly shiny

Able to visualise malleus through membrane and cone of light

Question 9

How is otitis media managed?

Answer 9

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

Question 10

How does otitis media appear on examination?

Answer 10

Bulging, red, inflamed tympanic membrane

If there is perforation may see discharge

Question 11

How are antibiotics prescribed to patients with otitis media?

Answer 11

Immediate antibiotics
Delayed prescription
None given

Question 12

When should antibiotics be prescribed at initial presentation?

Answer 12

Systemically unwell
Immunocompromised
Under 2 with bilateral otitis media
Otorrhoea

Question 13

When should a delayed prescription be collected?

Answer 13

After 3 days if symptoms have not improved or worsened at any time

Question 14

What antibiotics are used for otitis media?

Answer 14

Amoxicillin for 5 days

Erythromycin or clarithromycin if allergic

Question 15

What are the potential complications of otitis media?

Answer 15

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

Question 16

What is another name for otitis media with effusion?

Answer 16

Glue ear

Question 17

What happens in glue ear?

Answer 17

Middle ear becomes full of fluid causing hearing loss

Question 18

What causes otitis media with effusion?

Answer 18

Eustachian tube drains secretions from middle ear

When blocked, this causes middle ear secretions to build up causing glue ear

Question 19

What is the main complication of otitis media with effusion?

Answer 19

Infection, otitis media

Question 20

What does otoscopy in glue ear show?

Answer 20

Dull tympanic membrane
Air bubbles or visible fluid level

Can also look normal

Question 21

How is otitis media with effusion managed?

Answer 21

Audiometry referral

Conservative treatment

Question 22

How long does otitis media with effusion take to resolve usually?

Answer 22

Within 3 months

Question 23

When might a child require hearing aids or grommets?

Answer 23

Co-morbidities affecting ear structure e.g. Down’s syndrome or cleft palate

Question 24

What do grommets do?

Answer 24

Allow fluid from middle ear to drain through tympanic membrane to ear canal

Usually inserted under general anaesthetic as a day case

Question 25

How long are grommets used for?

Answer 25

Usually fall out within a year

1/3 patients may need to be reinserted for persistent glue ear