Acute Otitis Media

Inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation with/without an accumulation of fluid

Aetiology

• Predominantly disease of infants and children

• Often viral with bacterial secondary infection
• Commonly associated with URTIs
• Most common bacteria: H. influenzae, Strep. pneumoniae, Strep. pyogenes
• If chronic - Pseudomonas aeruginosa, Staph. aureus, fungal

Pathophysiology

• Infection extends from the throat to the ear via the Eustachian tube

Clinical presentation

Symptoms

• Ear pain

• Fever

• Irritability

• May have hearing loss

Signs

• Ear appears inflamed

• Middle ear effusion may be present

• Opaque tympanic membrane

• Bulging typanic membrane may be present

• Mobility of tympanic membrane may be impaired

Investigations

• Generally clinical diagnosis

• Swab of pus if eardrum perforates

Management

• 80% resolve in 4 days without antibiotics

• Amoxicillin/erythromycin if indicated

Complications

• Sensorineural hearing loss

• Tinnutus

• Acute mastoiditis

• Brain abscess/meningitis

• Vertigo

• Facial palsy

• Brain abscess/meningitis

• Venous sinus thrombosis