Otitis media dext

Otitis media refers to inflammation or infection of the middle ear cavity. The specific type of otitis media depends on various clinical findings and setting: It is most commonly seen .

Diagnosis

Management

Prescribing information

Background information

Otitis media - acute: Summary

  • Acute otitis media (AOM) is defined as the presence of inflammation in the middle ear, associated with an effusion, and accompanied by the rapid onset of symptoms and signs of an ear infection.
  • It is a common condition caused by viruses and bacteria.
  • AOM occurs frequently in children but is less common in adults.
    • It most commonly affects children from birth to 4 years of age, especially those who are subject to passive smoking, attend daycare or nursery, are formula-fed, or have craniofacial abnormalities (such as cleft palate).
  • Complications of AOM include recurrence of infection, hearing loss, tympanic membrane perforation, and rarely, mastoiditis, meningitis, intracranial abscess, sinus thrombosis, and facial nerve paralysis.
  • In older children and adults, AOM usually presents with earache. Younger children may hold or rub their ear or may have non-specific symptoms such as fever, crying, poor feeding, restlessness, cough, or rhinorrhoea.
  • On examination the tympanic membrane is distinctly red, yellow, or cloudy, and may be bulging.
  • Pain and fever should be managed with paracetamol or ibuprofen.
  • Many people with AOM will not need antibiotic treatment as symptoms usually resolve spontaneously within a few days. However, antibiotics are necessary in a number of situations, including for:
    • People who are systemically very unwell.
    • People who have symptoms and signs of a more serious illness or condition.
    • People who have a high risk of complications.
  • If an antibiotic is required, a 5–7 day course of amoxicillin is recommended first-line. Clarithromycin or erythromycin are alternatives for people who are allergic to penicillin (erythromycin is preferred in pregnant women).
  • The following groups of people should be admitted to hospital for immediate specialist assessment:
    • People with a severe systemic infection.
    • People with suspected complications of AOM, such as meningitis, mastoiditis, intracranial abscess, sinus thrombosis, or facial nerve paralysis.
    • Children younger than 3 months of age with a temperature of 38°C or more.
  • Management of persistent AOM involves:
    • Reassessing the person.
    • Considering the need for paediatric or ENT referral or admission, depending on the clinical situation.
    • Considering a first-line antibiotic (if not already prescribed) or a second-line antibiotic if the initial treatment was ineffective.
  • Measures to prevent recurrent AOM include:
    • In children — avoiding exposure to passive smoking, use of dummies, and flat, supine feeding; and ensuring that children have had a complete course of pneumococcal vaccinations as part of the routine childhood immunization schedule.
    • In adults — avoiding smoking and/or passive smoking.