Otitis media in adults

Question 1

Treatment of acute episode

Answer 1

Analgesics to relieve pain

Adequate rest in a warm room

Nasal decongestants for nasal congestion

Antibiotics for evidence of bacterial infection

Treat associated conditions (e.g. adenoid hypertrophy)

Follow-up: review and test hearing audiometrically

Question 2

Antibiotic treatment

Answer 2

First choice:

• Amoxycillin 750 mg (o) bd for 5 d or
• 500 mg (o) tds for 5 d

Alternatives:

• Doxycycline 100 mg (o) bd for 5–7 d (once/d for milder infections) or
• Cefaclor 375 mg (o) bd for 5–7 d or

If resistance to amoxycillin is suspected or proven:

• amoxycillin/potassium clavulanate 875/125 mg (o) tds for 5–7 d (the most effective antibiotic)

Question 3

Chronic otitis media

Answer 3

There are two types of chronic suppurative otitis media

• they both present with deafness and discharge without pain.

The discharge occurs through a perforation in the TM: one is safe, the other unsafe.