Otitis Media & Tonsillitis

Question 1

What is Otitis Media?

How common is it?

Answer 1

• It is a middle ear infection which is very common in children.
• Most children will have at least one episode of acute otitis media in their lifetime and this is most common at 6 - 12 months
• It can be caused by both viruses and bacteria.
• It can be classified as acute or chronic

Question 2

What are the signs and symptoms of otitis media?

Answer 2

• Child will complain of an ear ache.
  
  • Fever and pain in ear

O/e:

• The tympanic membrane will be visibly red and inflamed (will be bulging with a loss of the normal light reflex)
• There may be a perforation (this will cause a conductive loss).

Question 3

How is acute otitis media treated?

Answer 3

• Most cases of acute otitis media is self-limiting so will resolve by itself
• The pain may be treated with simple analgesia (e.g. paracetamol or ibuprofen)

Abx can marginally shorten the duration of pain but have not been shown to reduce the risk of hearing loss. Should be given if doesnt clear by 2-3 days

Question 4

What is chronic otitis media?

How does it look on examination?

Answer 4

• Chronic otitis media = Otitis media with effusion (the ear drum is seen to be dull and retracted, often with a visible fluid level)
• It is a chronic asymptomatic (apart from reduced hearing) condition in children

Also known as recurrent otitis media or otitis media with effusion (OME) or glue ear

Question 5

What are the signs of symptoms of chronic otitis media?

What age is it most common in?

Answer 5

• Causes a conductive hearing loss.
• Patient may be asymptomatic and it may present with delayed development or difficulty in school

O/e:

• Tympanic membrane will appear dull and retracted, may be able to see a fluid level.
• On tympanomomettry there will be a flat line

Most common in 2-7 year olds

Question 6

How is chronic otitis media (OME) treated?

Answer 6

It is self limiting

But in circumstances where the conductive hearing loss causes developmental delay in speech development and hence learning difficulties at school grommets (ventilation tubes) can be inserted

Question 7

What advice should you give to parents about how to care for a child with acute otitis media?

Answer 7

• Analgesia
• Support
• Reassurance
• Abx if not clear in 2-3 days (acute)

Question 8

What is tonsillitis?

What are the causative organisms?

Answer 8

• It is a form of pharyngitis in which there is swelling/inflammation of the palatine tonsils.
• It is commonly caused by group A strep and EBV. More commonly it is viral however.

Question 9

How can you differentiate between bacterial and viral tonsilitis?

Answer 9

It is not really possible to clinically distinguish

It is said that they look slightly different (look at picture)

Marked constitutional disturbances, such as headache, apathy and abdo pain, white tonsillar exudate and cervical lumphadenopathy are more common with bacterial infection

Question 10

What are the symptoms of tonsilitis? (6)

Answer 10

• Sore throat
• swollen tonsils.
• Cervical lymphadenopathy
• Headache
• malaise
• fever.

Question 11

What is the treatment for tonsillitis?

Answer 11

• If viral it is supportive if bacterial it is abx.
• In practice abx are reserved for more severe cases or persistent cases
• Avoid amoxicillin as it cause a papular rash if the tonsillitis is caused by EBV (glandular fever)

In severe cases children may require hospitalisation for IV fluids and analgesia if unable to swallow

Question 12

What are the indications for a tonsillectomy?

Answer 12

• 7 or more well documented, clinically significant, adequately treated sore throats in the preceding year

OR

• 5 or more such episodes in each of the preceding two years

OR

• 3 or more such episodes in each of the preceding three years
• Peritonsillar abscess
• Obstructive sleep apnoea