Otitis Media

Question 1

what is it?

Answer 1

infection of the middle ear which is seeded from the upper respiratory tract via the Eustachian tube
pathogens similar to URT infections - step. Pneumoniae, Haemophilus influenzae
Moraxella catarrhalis

Question 2

pathogenesis

Answer 2

infection causes inflammation of the middle ear mucosa and inflammatory exudate in the middle ear space

Question 3

who gets it?

Answer 3

children under 10

Question 4

how does it present?

Answer 4

Otalgia THEN discharge 
Otalgia 
Hearing disturbance 
Unresolved can lead to TM perforation and discharge 
Healthy ear canal 
Erythematous and occasionally bulging TM

Question 5

What are the rare complications?

Answer 5

Mastoiditis, the middle ear inflammatory fluid escapes from the middle ear into the mastoid
meningitis as the infection spreads through the tegmen into the intercranial cavity

Question 6

how is it managed?

Answer 6

NSAIDs
Often viral – will settle within 72 hrs with no antibiotics
If systemic fever or after 72 hrs then systemic antibiotic – amoxicillin
o Especially in children < 2 yrs
No point in topical therapy
Tenderness or swelling of mastoid – urgent ENT referral

Question 7

3 examples of chronic otitis media?

Answer 7

• Otitis media with effusion – glue ear
• Cholesteatoma
• Perforation

Question 8

what is OME?

Answer 8

otitis media with effusion

inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation

Question 9

who gets OME?

Answer 9

Age – any child (but decreasing with age)
M>F 
Increased incidence 
o	Day care
o	Older siblings 
o	Smoking household 
o	Recurrent URTI

Question 10

how does OME present?

Answer 10

Middle ear effusion
Opaque TM – may be absent, but fluid seen
Impaired TM mobility
Hearing loss

Question 11

how does acute otitis media present?

Answer 11

Earache, fever and irritability 
May be middle ear effusion 
Opaque TM 
May be a bulging TM
May be impaired TM mobility 
May be hearing loss

Question 12

how does perforation of the tympanic membrane arise?

Answer 12

can be a temporary or permanent defect

can arise from trauma or middle ear disease - recurrent infection

Question 13

how is perforation of the tympanic membrane managed?

Answer 13

surgical repair is indicated only if the patient is symptomatic with recurrent discharge
larger the perforation - larger the impact on hearing

Question 14

what is cholesteatoma?

Answer 14

keratinizing squamous epithelium within the middle ear cleft

Question 15

how does cholesteatoma present?

Answer 15

foul-smelling otorrhea

defect in the TM full of white cheesy material

Question 16

how is cholesteatoma managed?

Answer 16

mastoid surgery is needed to remove the sac of debris
it can erode local structures like ossicles or facial nerve if left or even extend intracranially to cause meningitis or an intracranial abscess