Otitis Media (Middle Ear Infection)

Last updated 13.02.13


Definition

-  Acute infection of middle ear with effusion

-  Recurrent = 3 episodes in 6/12 OR 4+ in 1yr

-  AOM (Acute Otitis Media) = middle ear fluid + mucosal inflammation

-  OME (Otitis Media with Effusion) = middle ear fluid without inflammation

 

Features

-  Often preceeded by viral URTI: RSV, Influenza, Rhinvirus

-  Acute onset

-  Usually self limiting

-  Often over diagnosed

-  Most common Dx in febrile children

-  Effects 80% children by age 6

-  Incidence reduces significantly by 7yrs old

 

Causes

-  Eustachian tube dysfunction

-  Seasonal allergic rhinitis

-  URTI

-  Naspharyngeal tumour

-  Enlarged adenoids

-  Cleft palatte or other craniofacial anomalies

-  Bacterial

-  Strep pneumonia (most common)

-  HIb

-  Moraxella catarrhalis

-  Viral

-  Uncommon

-  Candida

-  Aspergillus

-  Chlamydia trachomatis

-  Diptheritic otitis

-  Tuberculosis otitis

-  Otogenic tetanus

 

Associated S/S

-  Preceeding URTI or allergic rhinitis

-  Otalgia, pulling or tugging of ear

-  Typically unilateral

-  Improves if tympanic membrane perforates

-  Ear fullness

-  Decreased hearing

-  Usually transient

-  Ear Exan/Otoscopy

-  Tympanic membrane

-  Erythema

-  Dullness

-  Perforation

-  Effusion: bulging, air-fluid levels

-  Pneumatoscopy: limited/absent movement

-  Otorrhoea

-  +/- Fever

-  +/- Vomiting

-  +/- Dizzyness

 

Effusion

 

Complications

-  Acute mastoiditis

-  1:1,000 untreated --> Gradenigo syndrome

-  Posterior ear pain, mastoid erythema, oedematous pinna, downwards displaced auricle

-  More common in children than adults

-  Meningitis

-  Chronic otitis media

-  Chronic suppurative otitis media: purulent ottorrhoea

-  Chronic serous otitis media: serous (straw colored) otorrhoea

 

DDx

-  Otits externa

 

Ix

-  Vitals: fever

-  Otoscopy

-  Throat exam

-  +/- swab for MCS if ear discharge

 

Mx

-  Analgesia

-  Regular & adequate

-  NSAIDs

-  Paracetamol

-  Opiates is severe, short term

-  No evidence for improvement on decongestants or antihistamines

-  Ruptured Tympanic Membrane

-  Oral & topical antibiotics

-  Prevention of water entery into ear canal

-  Typically heals well in several days

-  Persistent subjective hearing loss after resolution of symptoms requires hearing test & referral to ENT

-  Perforation persisting >6 weeks should be referred to ENT

-  Follow Up

-  6/12 to 2yrs: symptomatic Mx + F/U 24hrs

-  >2yrs: symptomatic Mx, re-evaluate Mx in 2/7

-  Patient information (RCH)

-  Oral Antibiotics

-  Indictated if

-   <6 months old

-   Fever or vomiting

-   Tympanic membrane perforation

-   Lower threshold for adults

-  Amoxycillin

-   Children 15mg/kg PO 8/24 5/7

-   Adults 500mg PO 8/24 5/7

-   Severe cases 10/7

-  Hypersensitivity to penicillin: Cefuroxine 10mg/kg up to 500mg PO 12/24 5/7

-  No improvement in 48-72hrs: Augmentin DF

-   Children 22.5 + 3.2mg/kg PO 8/12 5-7/7

-   Adults 875/125mg PO 8/12 5-7/7

-  Topical Antibiotics

-  Indictated if

-  Ruptured tympanic membrane

-  Otodex (Dexamethasone 0.05% + Framycetin 0.5% + Gramicidin 0.005%) ear drops 3 drops in ear 6/24 for 3-7/7

-   Considered safe even if non-intact tympanic membrane for < 7 days

 

RCH

 

 

 

References

 

UpToDate: Acute Otitis Media in Adults, 12/02/201

RCH CPG: Acute Otitis Media