Otitis Media

Question 1

What is otitis media?

Answer 1

• it is an inflammation of the middle ear, sometimes associated with upper respiratory tract infection.

Question 2

What are the three classifications of otitis media?

Answer 2

• acute suppurative
• chronic suppurative
• serous / secretory

Question 3

Outline acute suppurative otitis media.

Answer 3

• may be caused by viral or bacterial infections, or - bacterial infection complicating a viral illness, it causes ear pain and tenderness

Question 4

Outline chronic suppurative otitis media.

Answer 4

• manifests as persistent drainage from the ear associated with tympanic membrane perforation and some degree of conductive hearing loss.
• chronic earconditions are not usually painful

Question 5

Outline serous/secretory otitis media.

Answer 5

• refers to non-suppurative fluid accumulation in the middle ear
• this condition is frequently associated with dysfunction or obstruction of the eustachian tube, such as may result from tonsillar hyperplasia or recurrent infection
• this condition is an important cause of hearing problems in children.
• in adults, a unilateral serous effusion may be due to a nasopharyngeal tumour which should be excluded

Question 6

In children what features must be present for us to suspect acute otitis media.

Answer 6

• Ear pain with or without fever

- Ear pain may be subtle in young, non-verbal children (tugging)

Question 7

What feature is a pre-requisite for the diagnosis of acute otitis media?

Answer 7

• The presence of middle ear effusion on otoscopy

Question 8

Which cohorts of patients should be offered antibiotics?

Answer 8

• under two years with bilateral infection
• with discharge from the ear
• who are systemically unwell (e.g. fever or vomiting)
• with recurrent infections

Question 9

What is the first-line choice of antibiotic?

Answer 9

Amoxicillin 5-7 days

Question 10

What is the first-line antibiotic choice in those who are pencillin allergic?

Answer 10

Clarithromycin 5-7 days (erythromycin if pregnant)

Question 11

What is the second-line antibiotic of choice?

Answer 11

Co-amoxiclav

Question 12

What surgical intervention may be necessary if antibiotic therapy does not work?

Answer 12

• Myringotomy (tympanostomy)
• Drains middle ear of fluid
• Complications include: persistent/transient ottorhoea; tympanosclerosis; atrophy; and cholesteatoma