Acute Otitis Media

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Introduction

Acute Otitis Media is an acute inflammation of the middle ear due to  pyogenic organisms.

It is usually secondary to upper respiratory tract infection spreading from nasopharynx.

It is common in infants and young children; and more frequent during winter and rainy periods.

The usual causative organisms are streptococcus pneumococcus and staphylococcus.

Symptoms and clinical features of acute otitis media

Main symptoms:

  1. Earache
  2. Fever
  3. Deafness
  4. Ear discharge
  5. Malaise
  6. In babies, irritability
  7. Clinically increasing inflammation and redness of the eardrum
  8. Later, perforation and pulsating
    mucopurulent discharge

Differential diagnoses

  • Acute otitis externa
  • Referred otalgia

Complications of acute otitis media

  1. Acute mastoiditis
  2. Facial nerve paralysis
  3. Labyrinthitis
  4. Intracranial
    • Meningitis
    • Brain abscesses
    • Lateral sinus thrombosis

Investigations

  • Ear swab for culture and sensitivity – swab taken properly without contamination
  • Full Blood Count

Treatment

Treatment objectives

  • Control infection
  • Restore normal hearing

Non-drug treatment

  • Ear toilet and antiseptic dressings
  • Myringotomy for persistent mucopurulent collection in middle ear with bulging eardrum

Drug treatment

A. Antibiotics

  • Amoxicillin

Adult: 500 mg-1 g orally every 8 hours for 5-7 days

Child: 40 mg/kg orally every 8 hours

B. Analgesics

  • Paracetamol

Adult: 500 mg-1g orally every 4-6 hours (to a maximum of 4 g) for 5-7 days

Child:

  • over 50 kg: same as adult dosing
  • 6-12 years: 250-500 mg;
  • 1-5 years: 125 – 250 mg;
  • 3 months 1 year: 125-250 mg for 5 – 7days

C. Systemic decongestant

  • Pseudoephedrine

Adult: 60 mg orally every 4 – 6 hours (up to 4 times daily)

Child:

  • 6-12years: 30mg (5mL of syrup) 3 times  daily;
  • 2-5years: 15mg, (2.5mL of syrup)

Supportive measures

  • Bed rest and adequate fluids

Notable adverse drug reactions, caution

  • Many preparations of pseudoephedrine contain antihistamines and may cause drowsiness
  • Avoid ear drops

Prevention

  • Good general health and clean airy
    environment to reduce incidence of upper respiratory infections (colds).

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