Otitis media

Question 1

Acute otitis media pathophysiology

Answer 1

Inflammation in the middle ear accompanied by the rapid onset of an ear infection presentation - commonly in children

Question 2

Causative organisms of acute otitis media

Answer 2

Bacterial:

• Haemophilus influenzae
• Streptococcus pneumoniae
• Moraxella catarrhalis
• Streptococcus pyogenes

Viral:

• respiratory syncytial virus
• rhinovirus
• adenovirus
• influenza virus
• parainfluenza virus

Question 3

Acute otitis media with effusion

Answer 3

Fluid in the middle ear, not associated with symptoms and signs of an acute ear infection

Fluid caused by a build up of exudate and causes TM retraction

Question 4

Why are children more likely to get acute otitis media

Answer 4

Acquire viral infections more often

Have shorter and more horizontal eustachian tubes

Question 5

Presentation of acute otitis media

Answer 5

Otalgia

Younger children - tugging at ear, fever, crying

Coexisting systemic
illness, such as bronchiolitis

Hearing loss - conductive

Question 6

Otoscopic findings of acute otitis media

Answer 6

Distinctly red, yellow, or cloudy tympanic membrane.

Bulging of the tympanic membrane, with loss of normal landmarks

Bubbles behind the tympanic membrane - effusion

Perforation of the tympanic membrane and/or discharge in the external auditory canal - suppurative OM

Question 7

Mx of acute otitis media

Answer 7

1. Advise usual course of acute otitis media is ~ 3 days, but can be up to 1 week.
2. Regular doses of paracetamol or ibuprofen for pain
3. 5–7 day course of amoxicillin back up
4. 5–7 day course of co-amoxiclav 2nd line
5. Clarithromycin if allergic or erythromycin if pregnant

Question 8

Otitis media with effusion pathophysiology

Answer 8

Causes:
- Impaired eustachian tube function causing poor aeration of the middle ear

• Low-grade viral or bacterial infection
• Adenoidal infection or hypertrophy

Question 9

Otitis media with effusion management

Answer 9

Observe for 6 - 12 wks as active resolution is common

• hearing aid
• grommets

Question 10

Most common causative bacteria for otitis media

Answer 10

Streptococcus pneumoniae

Question 11

When to give immediate antibiotics for otitis media

Answer 11

For patients who have significant co-morbidities, are systemically unwell or are immunocompromised