OTITIS MEDIA
DEFINITION
Inflammation and suppuration in middle ear cavity, mastoid antrum, and the Eustachian tube.
Inflammation and suppuration in middle ear cavity, mastoid antrum, and the Eustachian tube.
CAUSES
- Viruses
- RSV
- Rhinovirus
- Adenovirus
- Parainfluenza
- Bacteria
- Streptococcus pneumonia
- Moraxella catarrhalis
- Haemophilus influenza.
TYPES
- Acute Suppurative Otitis Media– <6 weeks
- Chronic Suppurative Otitis Media– >6 weeks.
Peak prevalence between 6 and 36 months of age
PREDISPOSING FACTORS
- Infants and young children (due to shorter Eustachian tube, larger adenoids)
- Parental smoking/ exposure to wood smoke
- Upper respiratory tract infections
- Familial history: (allergic rhinitis, asthma, cow’s milk allergy, parental atopy)
- Bottle feeding/ Pacifiers
- Measles, pertussis, tuberculosis
- Immunosuppression
- Cleft palate/ Down syndrome/ Craniofacial defects
CLINICAL FEATURES
- Acute Otitis Media
- Earache/ Purulent discharge
- Fever/ Cough (Most frequent symptoms)
- Hearing impairment
IN INFANTS
- Irritability
- Screaming
- Vomiting/ Fever
DIAGNOSIS
Otoscopy
- Injection of the vessels around the periphery
- Reddening with bulging of the eardrum
- Perforation and discharge
- Air-fluid levels
TREATMENT
The treatment duration for uncomplicated AOM is 5 – 7 days.
FIRST LINE ANTIBIOTICS
Amoxicillin
Amoxicillin
SECOND LINE ANTIBIOTICS.
If child not improving in 72 hours, then consider these
- Amoxicillin-clavulanate
- Erythromycin + Sulphonamide( In penicillin allergy)
- Trimethoprim-sulfamethoxazole
- Cefuroxime or Cefixime
If symptomatic > 3 days (on second-line antibiotic)- Tympanocentesis
- Clindamycin or intramuscular ceftriaxone as third-line agents
- Analgesics/ antipyretics- Paracetamol/ Ibuprofen
Re-evaluate two weeks after treatment for improvement
If in doubt, involve ENT
COMPLICATIONS
- Hearing impairment
- Acute mastoiditis
- Facial paralysis
- Intracranial complications(Extradural/ subdural abscess
- Meningitis