Otitis media

Question 1

What is acute otitis media?

Answer 1

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

Question 2

What is persistent acute otitis media?

Answer 2

as occurring when people return for medical advice with the same episode of AOM, either because symptoms persist after initial management or because symptoms are worsening.

Question 3

What is recurrent acute otitis media?

Answer 3

Recurrent AOM is generally defined as three or more well-documented and separate AOM episodes in the preceding 6 months, or four or more episodes in the preceding 12 months with at least one episode in the past 6 months

Question 4

Is otitis media caused by viruses or bacteria?

Answer 4

Acute otitis media (AOM) can be caused by both viruses and bacteria, and commonly both are present at the same time

Question 5

What are 4 of the most common bacterial pathogens that causes otitis medias?

Answer 5

1. Haemophilus influenzae, 2.Streptococcus pneumoniae, 3.Moraxella catarrhalis, 4. Streptococcus pyogenes

Question 6

What are some viral pathogens that cause otitis media?

Answer 6

respiratory syncytial virus (RSV), rhinovirus, adenovirus, influenza virus, and parainfluenza virus

Question 7

Who is acute otitis media common in?

Answer 7

Children are more likely to develop AOM because they acquire viral infections more often than adults, and have shorter and more horizontal eustachian tubes- Children from birth to 4 years of age are most likely to present with AOM

Question 8

What are the risk factors for otitis media?

Answer 8

• Young age.
• Male sex.
• Smoking and/or passive smoking.
• Frequent contact with other children such as daycare or nursery attendance or having siblings (increases exposure to viral illnesses).
• Formula feeding — breastfeeding has a protective effect.Craniofacial abnormalities (such as cleft palate).
• Use of a dummy
• .Prolonged bottle feeding in the supine position.
• Family history of otitis media.
• Lack of pneumococcal vaccination.
• Gastro-oesophageal reflux.
• Prematurity.
• Recurrent upper respiratory tract infection.
• Immunodeficiency.

Question 9

Are males or females more likely to contract otitis media?

Answer 9

Male

Question 10

What is the prognosis for patients not treated with antibiotics?

Answer 10

symptoms will improve within 24 hours in 60% of children with acute otitis media (AOM), and most people will recover within 3 days

Question 11

Are recurrent episodes of AOM common?

Answer 11

Recurrent episodes of AOM are not common but it is thought that recurrent AOM will resolve as the child gets older, often at 3–4 years of age Long term complications are rare

Question 12

What are some complications associated with otitis media?

Answer 12

• Persistent otitis media with effusion.
• Recurrence of infection.
• Hearing loss (usually conductive and temporary).
• Tympanic membrane perforation.
• Labyrinthitis.
• Rarely, mastoiditis, meningitis, intracranial abscess, sinus thrombosis, and facial nerve paralysis.

Question 13

What are some differential diagnosis’ of Otitis media?

Answer 13

1. Otitis media with effusion (glue ear)
2. Chronic suppurative otitis media
3. Myringitis
4. Earache

Question 14

What is Otitis media with effusion (glue ear)?

Answer 14

fluid in the middle ear without symptoms or signs of acute infection. On examination with an otoscope, an effusion and air fluid levels or bubbles are visible, with normal tympanic membrane landmarks.

Question 15

What is the most common presentation for glue ear?

Answer 15

The most common presentation is conductive hearing loss.

Question 16

What is Chronic suppurative otitis media?

Answer 16

persistent inflammation and perforation of the tympanic membrane with draining discharge for more than 2 weeks.

Question 17

What is Myringitis?

Answer 17

Myringitis or bullous myringitis is the inflammation of the tympanic membrane that can cause blisters on the eardrum. It’s a painful condition, and if left untreated, it can do damage to your hearing.

Question 18

Who should you admit for immediate specialist assessment of Otitis media?

Answer 18

• People with a severe systemic infection.
• People with suspected acute complications of acute otitis media (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.
• Children 3–6 months of age with a temperature of 39°C or more.

Question 19

What is the standard management of AOM?

Answer 19

usual course of antibiotics for acute otitis media is about 3 days, but can be up to 1 week. Advise regular doses of paracetamol or ibuprofen for pain, using a dosing schedule appropriate for the age and weight of a child.

Question 20

What is the management for people who do not require admission to hospital but are systemically very unwell, have symptoms and signs of a more serious illness or condition, or have a high risk of complications:

Answer 20

Offer an immediate antibiotic prescription. Advise them to seek medical advice if symptoms worsen rapidly or significantly or they become systemically very unwell

Question 21

What should be prescribed without the presence of an antibiotics?

Answer 21

For children or young people under the age of 18 who are not prescribed oral antibiotics and there is no ear drum perforation or otorrhoea, prescribe ear drops containing an anaesthetic and an analgesic

Question 22

What first line antibiotics should be prescribed for AOM?

Answer 22

Prescribe a 5–7 day course of amoxicillin.For people who are allergic to, or intolerant of, penicillin, prescribe a 5–7 day course of clarithromycin or erythromycin (erythromycin is preferred in pregnant women).

Question 23

What is the second choice for antibiotics?

Answer 23

The second choice oral antibiotic is to prescribe a 5-7 day course of co-amoxiclav where there are worsening symptoms on the first choice antibiotic taken for at least 2-3 days. Where a person has a penicillin allergy or is intolerant contact local specialist advice from a microbiologist.

Question 24

What should be reviewed if symptoms do not improve within 7 days?

Answer 24

1.Alternative diagnoses, such as otitis media with effusion (glue ear)
2. Any symptoms or signs suggesting a more serious illness or condition
3. Previous antibiotic use which may lead to resistant organisms

Question 25

How should I manage a person with recurrent acute otitis media?

Answer 25

Refer urgently (within 2 weeks) to an ear, nose, and throat (ENT) specialist if nasopharyngeal cancer (rare) is suspected, especially in the presence of any one of the following:

• Persistent symptoms and signs of otitis media with effusion in between episodes (for example, conductive hearing loss) due to obstruction of the eustachian tube orifice.
• Persistent cervical lymphadenopathy (usually in the upper levels of the neck).
• Epistaxis and nasal obstruction.

Question 26

What advice can be given to prevent the reoccurrence of AOM?

Answer 26

• In children — avoiding exposure to passive smoking, use of dummies, and flat, supine feeding.
• In children — ensuring they have had a complete course of pneumococcal vaccinations as part of the routine childhood immunization schedule, and that any gastro-oesophageal reflux disease (GORD) is managed appropriately.
• In adults — avoiding smoking and/or passive smoking.

Question 27

What should you not start in primary care?

Answer 27

Do not start long-term prophylactic antibiotics in primary care

Question 28

What generally causes Otitis media?

Answer 28

Inflammation and blockage of the Eustachian tube following chest infection, colds, flu and throat infection which can cause a build-up of mucus in the middle ear.

Question 29

What are the symptoms of otitis Media?

Answer 29

Earache.* Dulled hearing may develop for a few days. * Fever (high temperature). * Sometimes the eardrum perforates (bursts)

Question 30

What happens during an eardrum perforation?

Answer 30

This lets out infected mucus, and the ear becomes runny for a few days. As the pain is due to a tense eardrum, if the eardrum bursts, the pain often settles

Question 31

How quickly does a perforated eardrum recover?

Answer 31

A perforated eardrum usually heals quickly after the infection clears. It is important that during the next 6 weeks that the ear canal is kept dry during the healing process. Once the infection (and perforation) have cleared, your hearing should return to normal

Question 32

What is advised to avoid during treatment?

Answer 32

You are advised to prevent water from entering the ear canal during your treatment. You can prevent this when you have a shower by placing a piece of cotton wool coated in Vaseline in the outer ear

Question 33

What are complications of ear infections?

Answer 33

Some mucus may remain behind the eardrum after the infection is over. This may cause dulled hearing for a while. This usually clears within a week or so, and hearing then returns to normal. Sometimes the mucus does not clear properly and ‘glue ear’ may develop. Hearing may then remain dulled.