Acute Otitis Media

Question 1

what bacteria commonly cause acute otitis media?

Answer 1

• streptococcus pneumoniae
• haemophilus influenzae
• moraxella catarrhalis

Question 2

what is the pathophysiology of acute otitis media?

Answer 2

1. viral URTIs disturb the normal nasopharyngeal microbiome
2. allows bacteria to infect the middle ear via the eustachian tube

Question 3

what are the features of acute otitis media?

Answer 3

• otalgia - tug or rub ear
• fever
• hearing loss
• recent viral URTI

Question 4

what symptom will you see is the tympanic membrane perforates?

Answer 4

ear discharge

Question 5

what is seen on otoscopy in acute otitis media?

Answer 5

• bulging tympanic membrane –> loss of light reflex
• opacification or erythema of the tympanic membrane
• perforation with purulent otorrhoea
• decreased mobility if using a pneumatic otoscope

Question 6

what criteria is used to diagnose acute otitis media?

Answer 6

• acute onset of symptoms
• presence of middle ear effusion
• inflammation of tympanic membrane

Question 7

how is acute otitis media managed?

Answer 7

• generally self-limiting condition that does not require an antibiotic prescription
• analgesia

Question 8

when should antibiotics be given in acute otitis media?

Answer 8

• symptoms last >4 days
• systemically unwell
• immunocompromise or high risk of complications
• <2 years old
• otitis media with performation

Question 9

what antibiotic is given in acute otitis media?

Answer 9

5-7 day course of amoxicillin

Question 10

what is otorrhoea?

Answer 10

discharge from the ear

Question 11

what can result from unresolved acute otitis media with perforation?

Answer 11

chronic suppurative otitis media (CSOM)

Question 12

how is chronic suppurative otitis media defined?

Answer 12

perforation of the tympanic membrane with otorrhoea for >6 weeks

Question 13

what are the possible complications from acute otitis media?

Answer 13

• mastoiditis
• meningitis
• brain abscess
• facial nerve paralysis