Acute Otitis Media

Question 1

A 4 year old boy is brought to your practice with left ear pain, cough and fevers for 3 days. His mother has been giving regular analgesia for pain, but his symptoms have worsened today with increasing ear pain, screaming with pain, and difficulty hearing on the left side.

Answer 1

Impression
Given the escalating left ear pain over 3 days with associated URTI sx I am provisionally concerned about Acute otitis media in this patient.

Key Differentials to rule out include;
- Otitis externa
- Chronic otitis media
- mastoiditis -> meningitis/encephalitis
- Otitis interna
Other differentials to consider;
- viral URTI, COVID
- pneumonia

Goals

• targeted Hx/Ex/Ix, rule out complications of AOM,
• start empirical ABx treatment for AOM in this patient given 3 days of sx
• safety netting/ F/U

Question 2

AOM - Hx

Answer 2

Hx

• sx: preceding viral URTI, ear pain, hearing difficulties, sensation of pressure, irritability, lethargy/malaise,
• associated: cough, productive? volume, colour etc, fevers, chills, rigors
• RISKS: smoking, gas stove, recurrent, sick contacts, pets, indigenous, <6 months, immunocompromised
• Paeds hx: developmental milestones, details of birth/pregnancy, immunisations
• SNAP

Question 3

AOM - Ex

Answer 3

Examination
- General appearance + vitals
- ENT examination
o Ears: tympanic membrane for redness, swelling, loss of light reflex, fluid level, perforation and effusion. External ear tenderness

Question 4

AOM - Ix

Answer 4

Investigations

Nil required as is a clinical diagnosis.

Question 5

AOM - Mx

Answer 5

Management
Non-pharmacological
- analgesia
- antipyretics
- rest at home
- sinus rinses
- safety-netting around sx of systemic infection, when to return to GP
- review at 3 months to ensure no chronic otitis media

Pharmacological
- Empirical ABx: Amoxicillin

Other definitive
- if recurrent/chronic consider referral to ENT for ?grommet insertion