Acute Otitis Media

Introduction

Acute otitis media is a self-limiting middle ear infection that mainly affects children.

  • A viral cold, especially in children, can lead to blockage of the Eustachian tube and fluid formation within the middle ear. This causes symptoms of pressure and pain (otalgia). Sometimes, the fluid can then secondarily infected by a bacterial infection.



Symptoms

Acute otitis media is most common in children up to the age of 4 years old.

  • In young children, it is often manifested as irritability or crying, with characteristic ear tugging/rubbing.
  • In older children, ear pain (earache) is the predominant feature and tends to be throbbing.
  • Systemic symptoms, such as fever and loss of appetite, can also be present.

An examination of the ear should reveal a red-yellow and bulging tympanic membrane, with a loss of normal land-marks.



Management

Over three-quarters of episodes resolve within 3 days (but it can last up to 1 week) without treatment; current guidelines do not advocate the routine use of antibiotics in children.

  • Initial antibiotic therapy does not improve pain at 24 hours.
  • Antibiotics only shorten the duration of symptoms by about 12 hours.
  • Antibiotic therapy can cause harm (e.g. diarrhoea, rash or more serious hypersensitivity reactions, bacterial resistance).

Adequate and regular analgesia (paracetamol or NSAID) is the mainstay of acute otitis media treatment.



Referral to Doctor

The following cases should be referred for consideration of antibiotics (e.g. a 5- to 7-day course of amoxicillin).

  • Children under 2 years of age with bilateral otitis media
  • Children at high risk of complications (e.g. infants <6 months of age, immunocompromised children)
  • Otorrhea (discharge following perforation of eardrum) is present
  • They are systemically unwell (e.g. high fever, very restless, vomiting)
  • Symptoms worsen or do not improve within 48 to 72 hours.



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