Otitis Media Flashcards
What is the definition of acute otitis media?
Inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation with/without an accumulation of fluid
What is the aetiology of otitis media?
Predominantly infants and children
Often viral with bacterial secondary infection (H.influenzae, strep. pneumoniae, strep. pyogenes)
What is the pathophysiology of acute otitis media?
Infection spreads from throat to ear via Eustachian tube
What are the clinical features of acute otitis media?
Ear pain
Fever
Irritability
May have hearing loss
On otoscopy:
Inflamed ear
May have middle ear effusion
Opaque tympanic membrane
Bulging tympanic membrane
Impaired mobility of tympanic membrane
What are some investigations for acute otitis media?
Clinical diagnosis
Swab of pus if eardrum perforates
What is the management of acute otitis media?
Generally self limiting and resolves in 4 days without antibiotics
Analgesia
Seek medical advice if symptoms worsen or don’t improve after 3 days
Antibiotics (amoxicillin/erythromycin) if:
- >4 days/not improving
- Systemically unwell
- Immunocompromised or high risk of complications
- <2 yrs with bilateral otitis media
- Perforation and/or discharge
What are some complications of otitis media?
Sensorineural hearing loss
Tinnitus
Acute mastoiditis
Brain abscess/meningitis
Vertigo
Facial palsy
Venous sinus thrombosis
What are some risk factors for otitis media with effusion (‘glue ear’)?
Day care
Older siblings
Smoking household
Recurrent URTI
Craniofacial/genetic abnormality
Prematurity
Immunodeficiency
What is the clinical presentation of otitis media with effusion?
Often asymptomatic
Hearing loss (poor school performance, behaviour problems, speech delay)
Visible fluid/bubbles on otoscopy
Altered tympanic membrane colour/retraction/mobility
What are some investigations for otitis media with effusion?
Otoscopy
Tuning fork tests (conductive hearing loss)
Audiometry
Tympanometry
What is the management of otitis media with effusion?
‘Watchful waiting’ with explanation to parent that generally transient and 90% resolve after 3 months
Review at 3 months for otoscopy and hearing assessment
Surgical option- grommets
