otitis media

Question 1

in which age group is acute otitis media extremely common in?

Answer 1

young children, around 1/2 of children having 3 or more episodes by the age of 3 years

Question 2

what is the pathophysiology of acute otitis media?

Answer 2

• most infections are 2˚ to bacteria: strep pneumoniae, haemophilus influenzae, moraxella catarrhalis
• viral URTIs are thought to disturb normal nasopharyngeal microbiome → allowing bacteria to infect middle ear via Eustachian tube

Question 3

what are the features of otitis media?

Answer 3

otalgia + tug/rub ear

• fever (50%)
• hearing loss
• recent viral URTI sx
• ear d/c if TM perforates

Question 4

what are the possible otoscopy findings of otitis media?

Answer 4

1. bulging TM → loss of light reflex
2. opacification / erythema of TM
3. perforation with purulent otorrhoea
4. decreased mobility if using pneumatic otoscope

Question 5

what are the criteria used to diagnose otitis media?

Answer 5

1. acute onset of sx
   
   • otalgia / ear tugging
2. presence of middle ear effusion
   
   • bulging of TM
   • otorrhoea
   • decreased mobility on pneumatic otoscopy
3. inflammation of TM
   
   • erythema

Question 6

how is acute otitis media managed?

Answer 6

self-limiting condition, does not require abx prescription (however there are some exceptions)

1. analgesia to relieve otalgia
2. seek medical help if sx worsen / do not improve after 3 days

Question 7

when should abx be prescribed for acute otitis media?

Answer 7

1. sx lasting more than 4 days / not improving
2. systematically unwell but not requiring admission
3. immunocompromised / high risk of complications 2˚ to signifcant lung, kidney, liver or neuromuscular disease
4. younger than 2 years with bilateral otitis media
5. otitis media with perforation +/- discharge in the canal

Question 8

if you decide to rx with abx, what abx is given for acute otitis media?

Answer 8

5-7 day course of amoxiillin (first-line)

Question 9

what abx is given if pt has a penicillin allergy?

Answer 9

erythromycin or clarithromycin

Question 10

what are the sequelae for otitis media?

Answer 10

1. perforation of TM → otorrhoea
   
   • unresolved acute OM with perforation may develop into chronic suppurative OM (CSOM)
   • CSOM = perforation of TM with otorrhoea > 6 wks
2. hearing loss
3. labyrinthitis

Question 11

what are the complications of acute otitis media?

Answer 11

1. mastoiditis
2. menigitis
3. brain abscess
4. facial nerve paralysis