Otitis Media Flashcards
What is otitis media?
Usually viral Infection and inflammation of the middle ear cavity, high incidence especially in under 5s. Can become bacterial. Usually occurs as a result of eustachian tube dysfunction.
What are the risk factors for otitis media?
URTI Bottle feeding Passive smoking Dummy/pacifier Presence of adenoids Asthma Malformations GOR Raised BMI
What organisms cause bacterial otitis media?
Acute otitis media is commonly bacteria Strep pneumoniae Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus.
What are the signs and symptoms of otitis media?
Rapid onset of symptoms
Ear pain
Fever
Irritability (in infants) and anorexia
Often accompanied by URTI in children
Discharge – mucous based and indicated perforation
Bulging of the ear drum causing pain which is relieved when it is burst
How is otitis media managed?
Encourage exclusive breast feeding of children
Adequate analgesia but generally, otitis media resolves without treatment within a day or so
Consider immediate or 2-day delayed antibiotics if:
AOM in children <3months
Perforation/discharge
<2yrs with bilateral OM
Symptoms lasting more than 4 days or not improving
Systemically unwell or immunocompromised
Antibiotics used should be amoxicillin for 5 days (erythromycin if allergic)
Be aware of progression – CT may be required – Mastoiditis and Intracranial complications – meningitis, abscess, and thrombosis.
What is chronic otitis media?
Discharge from the ear canal for 2 weeks or longer
This can be active (discharging) or inactive (non-discharging) Mucosal disease (perforation) Squamous disease (cholesteatoma if active or retracted pocket if inactive)
What are the clinical features of chronic otitis media?
Persistent discharge
Hearing loss
Fullness
Otalgia
Benign (inactive) COM – dry tympanic membrane perforation without active infection
Chronic serous OT – continuous serous drainage
Chronic suppurative (CSOM) – persistent purulent discharge through a perforated drum. Perforation either in pars tens or pars flaccida with a cholesteatoma.
How should chronic otitis media be investigated?
Swabs
Consider CT
How should chronic otitis media be managed and how does the location of the perforation change its management?
Topical/systemic antibiotics
Cleaning canal
Avoid water when perforated
Surgery may be required (CSOM) – mastoidectomy or myringoplasty (repair of membrane using graft from temporalis fascia or tragal perichondrium)
Generally, pars tensa perforations can be managed non-operatively or with a myringoplasty. Pars flaccida perforations require radical mastoidectomy.
What is glue ear?
Otitis media with effusion within the middle ear
What are the causes and risk factors of glue ear?
Dysfunction of the Eustachian tube (usually from URTI or adenoiditis) resulting in negative pressure within the middle ear and the resulting exudate formation which then becomes infected.
More common in boys, Down’s syndrome, cleft palate, during the winter, atopy, children of smokers and primary ciliary dyskinesia.
What are the clinical features of glue ear?
Conductive hearing loss (most common cause)
Consequential speech impairment, behavioural difficulties and learning difficulties
Rarely causes pain so easily missed
Often bilateral
Middle ear effusion on otoscopy
How should glue ear be investigated?
Otoscopy – bulging or retracted drum with bubbles or fluid seen behind it
Formal testing of hearing – audiometry, tympanometry
How is otitis media with effusion managed?
Usually mild, transient and resolves by itself.
Active observation for 3 months – advice to reduce impact of hearing loss e.g. reducing background noise. Reassess after 3 months. Auto inflation of ET may be useful during this time.
If child with down’s syndrome or cleft palate, then refer immediately for specialist assessment.
DO not treat with antibiotics, antihistamines, mucolytics, decongestants or corticosteroids.
Surgery – if persistent and bilateral then grommets or tympanostomy can be considered. (complications of grommets are infections and tympanosclerosis). Note it is okay to swim with grommets. They usually fall out after 12 months – check hearing at this point.
