Otitis Media in Children

Question 1

Acute Otitis Media Five Subtypes

Answer 1

• AOM: acute inflammation of the middle ear from bacteria or viruses
• OME: chronic condition without acute inflammation, follows AOM
• CSOM: long standing suppurative middle ear inflammation usually with persistently perforated tympanic membrane
• Mastoiditis: Infection of periosteum and air cells spread from AOM
• Cholesteatoma: Skin present in middle ear due to tympanic membrane retraction

Question 2

Acute Otitis Media Pathophysiology

Answer 2

• Infecting organisms reach middle ear from the nasopharynx
• In children, Eustachian tube flatter, so organisms can more easily travel through
• Therefore AOM usually a complication of respiratory infection (H. influenzas, S. pneumonia…)
• RSV, rhinovirus

Question 3

Acute Otitis Media Presentation

Answer 3

• Pain, malaise, fever, coryza, irritability
• High temp, red, yellow or cloudy tympanic membrane
• Bulging tympanic membrane, air fluid level, discharge

Question 4

Acute Otitis Media Differentials

Answer 4

OE, OME, RTI

Question 5

Acute Otitis Media Investigations

Answer 5

• Usually none
• Culture if recurrent
• Audiometry if indicated

Question 6

Acute Otitis Media Management

Answer 6

• 5 day course amoxicillin if systemically unwell or high risk
• Admit if under 3 months with temp of 38C or more, if over 3, admit if 39C or more
• Admit if meningitis, mastoiditis, facial nerve palsy
• Otherwise treat with OTC pain relief and do not routinely prescribe antibiotics

Question 7

OME RFs

Answer 7

• Most cases follow AOM
• OME may occur due to: Eustachian tube dysfunction, low grade infection, chronic colonisation of the adenoids)
• More common in craniofacial malformations and Down’s syndrome

Question 8

OME Presentation

Answer 8

• Hearing loss is usual presenting symptoms
• Mild intermittent pain with fullness
• Opacification of the drum
• No signs of inflammation
• Loss of light reflex
• Indrawn drum

Question 9

OME Investigations

Answer 9

• Observe for 3 months, if no improvement refer

- Unilateral OME in adults is suspicious finding

Question 10

OME Management

Answer 10

• Usually self limiting

- If persistent with moderate hearing loss, refer for grommets