Otitis media

• What is otitis media?


  Inflammation of middle ear

  Can be due to bacterial or viral infection
• What age is the peak incidence of acute otitis media?


  6-15 months
• Why is otitis media more common in children?


  Angle between Eustachian tube & wall of pharynx

  
• What are the most common causes of otitis media?


  Streptococcus pneumoniae

  Haemophilus influenzae

  Moraxella catarrhalis

  RSV

  Adenovirus

  Enterovirus
• What are the RFs of otitis media?


  Age < 2 yrs

  Male

  Parental smoking

  Immunodeficiency

  Formula feeding

  Attendance at nursery

  Structural abnormalities (Down's syndrome, presence of cochlear implants)

  NOTE: recurrence is more common in children with GORD or those who use dummies.
• What are the signs & symptoms of otitis media?


  Earache

  Ear tugging in younger children

  Pain

  Fever

  Irritability

  Anorexia

  Vomiting

  Erythema of TM

  Presence of effusion in middle ear

  Evidence of perforation -> tear in TM or discharge from ear
• What is shown in the image?

  Otitis media

  
• What are the red flag symptoms that may indicate intracranial spread of infection?

  Changes to vision

  Photophobia

  Headache

  Nystagmus (involuntary eye movements)

  Post auricular swelling

  Facial paralysis
• What are the DDx of acute otitis media?


  Chronic benign otitis media

  Otitis media with effusion (glue ear)

  Chronic suppurative otitis media

  URTI

  Mastoiditis

  Otitis externa
• What are the Inx for otitis media?


  Obs

  Full Hx & examination (otoscopy)

  Culture of discharge (if acute otitis media is chronic or recurrent)

  CT/MRI -> if concerned about mastoiditis or intracranial spread

  Audiometry
• What is the management of acute otitis media?


  Reasurrance - usually clears within 3-5 days

  Abx (amoxicillin/clarithromycin for 5-7 days) -> if child is systemically unwell

  Analgesia

  Eardrops containing anaesthetic & analgesia

  Consider delayed Abx if symptoms don't improve within 3 days

  Children can return to school when apyrexial
• When should children be admitted with acute otitis media?


  Children < 3 months with temp of 38 or more

  Children with suspected acute complications -> meningitis, mastoiditis or facial nerve palsy

  Children who are severely systemically unwell
• What are the possible complications of otitis media?

  Facial nerve palsy

  Mastoiditis

  Petrositis

  Labyrinthitis

  Meningitis

  Sigmoid sinus thrombosis

  Brain abscess

  Hearing loss

  Otitis media with effusion

  Chronic suppurative otitis media
• What is recurrent acute otitis media?


  More than 3 episodes of acute otitis media in 6 months

  OR

  More than 4 episodes in 1 yr