Otitis media

Question 1

Definition of otitis media

Answer 1

• Acute infection of the middle ear
  
  • Most common at 6-12 months of age

Question 2

Aetiology of otitis media

Answer 2

• Viral (most common)
  
  • RSV
  • Rhinovirus
• Bacterial
  
  • Streptococcus pneumoniae
• Eustachian tubes (in infants and young children)
  
  • Short
  • Horizontal
  • Function poorly

Question 3

Presentation of otitis media

Answer 3

• History
  
  • Otalgia
  • Fever
  • URTI
• Examination
  
  • Erythematous, bulging tympanic membrane (pathognomic)

Question 4

Complications of otitis media

Answer 4

• Mastoiditis
• Meningitis

Question 5

Investigations for otitis media

Answer 5

• Clinical diagnosis

Question 6

Management of otitis media

Answer 6

*Most cases resolve spontaneously*

• Analgesia
  
  • Paracetamol/ibuprofen
• Antibiotics (amoxicillin)
  
  • Marginally shorted duration of symptoms
  • Delayed prescription may be useful (if child does not improve, take antibiotics in 2-3 days)

Question 7

Otitis media with effusion

• History
• Examination
• Complications
• Investigations
• Management

Answer 7

• Occurs with recurrent ear infections
• History
  
  • Asymptomatic
  • Reduced hearing in the affected ear
• Examination
  
  • Dull tympanic membrane with fluid level
  • Conductive hearing loss with Weber and Rinne’s test
• Complications
  
  • Speech and learning difficulties from hearing loss
• Investigations
  
  • Tympanometry
  • Pure tone audiometry
• Management
  
  • Resolve spontaneously
  • Grommets
  • Adenoidectomy