Otitis Media Flashcards
(25 cards)
What is otitis media?
An infection of the middle ear
Where is the middle ear?
Air-filled space behind the tympanic membrane and in front of the inner ear. Contains the malleus, incus and stapes. Also connects to the back of the nose via the Eustachian tube.
How does the middle ear become infected?
Bacteria enter from the back of the throat through the Eustachian tube.
Often preceded by a viral upper respiratory tract infection.
what is the most common bacterial cause of otitis media?
Streptococcus pneumoniae
(also most common cause of rhino-sinusitis and tonsillitis)
Name the common bacterial causes of otitis media
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staph aureus
How does otitis media generally present?
Ear pain
Reduced hearing in affected ear
Upper airway infection sx (fever, cough, sore throat, unwell)
When an infection affects the vestibular system, what other disturbances may be experienced?
Balance issues and vertigo
What does discharge from the ear suggest?
Perforation of tympanic membrane
What should be examined in unwell children (despite any ear complaints or not)
Both ears and the throat
What is used to visualise the tympanic membrane?
Otoscope
How should the tympanic membrane appear in a healthy child?
Pearly-grey
Translucent
Slightly shiny
Should be able to see malleus through membrane and a cone of light reflecting light of otoscope
How does the tympanic membrane look in child with otitis media?
Bulging, red and inflamed looking membrane.
May see discharge and a hole if perforated
True or false: otitis media infections must be treated quickly with empirical antibiotics
False
Most cases will resolve without antibiotics in 3 days. Can last a week.
Give simple analgesia
When should antibiotics be prescribed for otitis media in children?
Consider if child has significant co-morbidities, are systemically unwell or are immunocompromised.
If child is less than 2 y/o with bilateral otitis media
Children with Otorrhoea (discharge)
Can give delayed prescription that can be collected after 3 days is sx not improved or worsened at any time
What is the first line choice of antibiotics for otitis media requiring antibx?
Amoxicillin for 5 days
Or erythromycin or clarithromycin.
What are some complications of otitis media?
Otitis media with effusion
Hearing loss (usually temporary)
Perforated ear drum
Recurrent infection
Mastoiditis (rare)
Abscess (rare)
What is mastoiditis?
Infection in part of the temporal bone when otitis media spreads.
Sx include tenderness and red behind ear, discharge, fever, headache and trouble hearing.
How is mastoiditis treated?
Admission under ENT
IV antibx
Possible surgical drainage and possible grommet
Possible mastoidectomy
What are grommets?
Small plastic tubes inserted into eardrum to help drain fluid and equalise pressure in the middle ear
What are grommets commonly used to treat?
“Glue-ear” (fluid build-up) and recurrent ear infections
Inserted typically under brief general anaesthetic
How long do Grommets last?
Typically they fall out within 6-18 months as the eardrum grows and the eardrum heals well.
What is Otitis media with effusion also called?
Glue-ear
What happens in Glue-ear?
The middle ear becomes full of fluid, causing hearing loss.
Often due to blocked Eustachian tube so can’t help drain secretions.
What would be seen with an otoscope in Glue-ear?
Dull tympanic membrane with air bubbles or visible fluid level
(Can look normal)
