Otitis Media

Question 1

What is Otitis Media?

Answer 1

• This is the name given to an infection in the middle ear

Question 2

How does the middle ear get infected?

Answer 2

• Bacteria enter from the face of the throat through the Eustachian Tube
• A viral upper respiratory tract infection often precedes the bacterial infection of the middle ear

Question 3

What are the common bacteria’s causing Otitis Media?

Answer 3

• Streptococcus Pneumoniae
• Haemophilus Influenza
• Moraxella Catarrhalis
• Staphylococcus Aureus

Question 4

How does Otitis Media Present?

Answer 4

• Ear Pain
• Reduced Hearing
• Fever
• Cough, Coryzal symptoms and sore throat

Question 5

What are the symptoms of Otitis Media when the infection affects the Vestibular System?

Answer 5

• It can cause balance issues and vertigo
• When the tympanic membrane has perforated, there may be discharge in the ear

Question 6

What examinations would you do for Otitis Media?

Answer 6

• Otoscope to visualise the tympanic membrane
• This will present with a bulging, red, inflamed looking membrane
• When there is a perforation, you may see discharge in the ear canal and cause a hole in the tympanic membrane

Question 7

What is the management for Otitis Media?

Answer 7

• Analgesia (paracetamol or ibuprofen)
• Antibiotics ( Amoxicillin - 5/7 days, Clarithromycin (penicillin allergy), Erythromycin (pregnant women allergic to penicillin)

Question 8

What are the Complications of Otitis Media?

Answer 8

• Otitis media with effusion
• Chronic Suppurative Otitis Media
• Hearing loss
• Perforated tympanic membrane
• Labyrinthitis
• Mastoiditis
• Abscess
• Facial Nerve Palsy
• Meningitis

Question 9

What are the possible otoscopy findings for Otitis Media?

Answer 9

• Bulging Tympanic Membrane = loss of light reflex
• Opacification or erythema of the tympanic membrane
• Perforation with purulent otorrhoea
• Decreased mobility if using a pneumatic otoscope

Question 10

What criteria is there to diagnose Otitis Media?

Answer 10

• Acute Onset of Symptoms (Otalgia/ ear tugging)
• Presence of a middle ear effusion ( bulging of the tympanic membrane/ otorrhoea/ decreased mobility on pneumatic otoscopy)
• inflammation of the tympanic membrane (erythema)

Question 11

Should you prescribe antibiotics for Otitis Media?

Answer 11

• Generally no as Otitis Media is considered a self-limiting condition
• Review if symptoms do not improve after 3 days

Question 12

When should Antibiotics be prescribed immediately in Otitis Media?

Answer 12

• Symptoms lasting more than 4 days
• Systemically unwell
• Immunocompromised as there is a high risk of complications
• Younger than 2 years with Bilateral Otitis Media
• Otitis Media with perforation/ discharge in the canal

Question 13

What is Chronic Suppurative Otitis Media (CSOM)?

Answer 13

• CSOM is defined as perforation of the tympanic membrane with otorrhoea for > 6weeks