otitis media

Question 1

what

Answer 1

infection of middle ear

Question 2

what is middle ear

Answer 2

space between TM and inner ear

cochlea
vestibular apparatus
nerves

Question 3

how can bacteria get to middle ear

Answer 3

from back of throat through eustachian tube

Question 4

what often precedes a bacterial infection of middle ear

Answer 4

viral UTRI

Question 5

most common cause

Answer 5

strep pneumoniae

Question 6

other causes

Answer 6

H influenzae
moraxella catarrhalis
staph a

Question 7

features

Answer 7

ear pain
reduced hearing
fever
cough, coryzal symptoms

if affects vestibular system - balance issues + vertigo

if TM perforated - discharge from ear

Question 8

otoscopy findings

Answer 8

bulging, red, inflamed TM

if perforation: discharge + hole in TM

Question 9

Mx

Answer 9

• most resolve w/o antib in 3-7days
• simple analgesia
• antib
• safety netting

Question 10

when to consider immediate antib

Answer 10

significant co-morbidities
systemically unwell
immunocompromised

Question 11

delayed antib prescription

Answer 11

can be collected and used after 3 days if symptoms not imporved

Question 12

antibiotic choice

Answer 12

1. amoxicillin 5-7 days

if penicillin allergy - clarithromycin

if pregnancy + penicillin allergy - erythromycin

Question 13

complications

Answer 13

otitis media with effusion 
hearing loss
perforated TM 
labrynthitis
mastoiditis
abscess
CNVII palsy 
meningitis