Otitis Media

Question 1

Define otitis media

Answer 1

Infection in middle ear (space between tympanic membrane and inner ear)

Question 2

Otitis media aetiology

Answer 2

Often preceded by viral URTI

Most common bacterial cause is Strep. pneumoniae

Other common causes:
H. influenzae
Moraxella catarrhalis
Staph. aureus

Question 3

Clinical features of otitis media

Answer 3

Ear pain - tugging

Reduced hearing in affected ear

General symptoms of upper airway infection

Build-up of fluid behind ear drum results in conductive hearing loss (Rinne’s)

If infection affects vestibular system: balance issues, vertigo

If tympanic membrane perforated there may be discharge

Question 4

General symptoms of upper airway infection

Answer 4

Fever

Cough

Coryzal symptoms

Sore throat

Generally unwell

Question 5

Pathophysiology of otitis media

Answer 5

Bacteria enter from back of throat trough eustachian tube

Question 6

Investigations in otitis media

Answer 6

Always examine ears and throat of unwell children

Bulging, red, inflamed membrane

Question 7

Management of otitis media

Answer 7

Analgesia as first line

Indications for antibiotics in children are:
Perforated eardrum
<2 years old and bilateral
Present for ≥4 days
<3 months old

Question 8

Management of recurrent otitis media

Answer 8

Refer for grommet insertion

Insertion of grommets twice is an indication for tonsillo-adenectomy

Glue ear (recurrent otitis media) is a common presentation of conductive hearing loss in children

The major concern is whether it affects the child’s speech and language development, and whether there are any problems in school

Question 9

What are grommets?

Answer 9

Thin tubes sitting in the ear drum that allow fluid to pass from behind the ear drum to be discharged

Question 10

Otitis media complications

Answer 10

Otitis media with effusion

Hearing loss (usually temporary)

Perforated eardrum

Recurrent infection

Mastoiditis (rare)

Abscess (rare)

Question 11

Mastoiditis

Answer 11

Requires imaging with CT

Pain on palpation of the mastoid process

Laterally and inferiorly displaced pinna

Thick purulent discharge