Otitis media Flashcards
Define acute otitis media
Inflammation in the middle ear that is accompanied by the rapid onset of symptoms and signs of an ear infection, associated with effusion
Define persistent otitis media
Symptoms persist after initial management or because symptoms are worsening
Define recurrent otitis media
3 or more well-documented and separate AOM episodes in the preceding 6 months, or 4 or more episodes in the preceding 12 months
What are the causes of acute otitis media
Bacterial:
* Haemophilus influenzae
* Streptococcus pneumoniae
* Moraxella catarrhalis
* Streptococcus pyogenes
Viral:
* RSV
* Rhinovirus
* Adenovirus
* Influenza virus
* Parainfluenza virus
What are the risk factors for acute otitis media
- 6-24 months of age
- Winter season
- Lack of pneumococcus vaccination
- Male sex
- Smoking and/or passive smoking
- Frequent contact with other children e.g. daycare, nursery, siblings
- Formula feeding (breastfeeding is protective)
- Craniofacial abnormalities e.g. cleft palate
- Dummy usage
- Prolonged bottle feeding in supine position
- FHx otitis media
- Gastro-oeseophageal reflux
- Recurrent URTI
- Immunodeficiency
What are the symptoms otitis media
Older children/adults: earache
Younger children:
* Holding, tugging, rubbing of the ear
* Fever
* Crying
* Poor feeding
* Restlessness
* Behavioural change
* Cough
* Rhinorrhoea
What are the signs of otitis media on examination
Otoscopic ear examination
* Red, yellow, or cloudy tympanic membrane
* Bulging of the tympanic membrane
* Loss of normal landmarks
* Air-fluid level behind the tympanic membrane (indicates a middle ear effusion)
* Perforation of the tympanic membrane and/or discharge in the external auditory canal
What investigations should be done for otitis media
Basic observations
Otoscopic examination
Pneumatic otoscopy: impaired ear drum mobility
What features necessitate admission for otitis media
Severe systemic infection
Less than 3 months old with temp. >38oc
Immunocompromised
Suspected acute complications:
- Meningitis
- Mastoiditis
- Intracranial abscess
- Sinus thrombosis
- Facial nerve paralysis
What is the a management for otitis media in a child who is systemically well
Supportive:
* Advise on the course of disease (3-7 days)
* Will resolve spontaneously, seek help if symptoms do not improve
* Paracetamol or ibuprofen for pain
* Back-up Abx prescription
* Ear drops with anaesthetic/analgesic:
*```
Contraindicated: ear drum perforation, otorrhoea
* For children <18yo who are not prescribed antibiotics
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What is the management for a child with otitis media who is systemically unwell
First line: amoxicillin for 5-7 days
Second line: co-amoxiclav
+supportive
What is the management for acute otitis media with perforation
Oral amoxicillin, 5 days
Review in 6 weeks to ensure healing
What are the compliclations of acute otitis media
Persistent otitis media with effusion
Recurrence of infection
Hearing loss (usually conductive and temporary)
Tympanic membrane perforation
Labyrinthitis
Mastoiditis, meningitis, intracranial abscess, sinus thrombosis, facial nerve paralysis
What is the prognosis for acute otitis media
Excellent prognosis
Without antibiotic treatment: symptoms improve within 24 hours in 60% of children, most recover within 3 days
Recurrent episodes are not common, but if they are present they usually resolves as the child gets older
Long term complications are rare
Define chronic suppurative otitis media
A chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges (otorrhoea) through a tympanic perforation
Persistent (>2 weeks) drainage through an eardrum perforation
