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Otitis Media Lawrence Pike. Definition Inflammation of the middle ear nearly always preceded by an URTI. Inflammation of the middle ear nearly always.

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Presentation on theme: "Otitis Media Lawrence Pike. Definition Inflammation of the middle ear nearly always preceded by an URTI. Inflammation of the middle ear nearly always."— Presentation transcript:

1 Otitis Media Lawrence Pike

2 Definition Inflammation of the middle ear nearly always preceded by an URTI. Inflammation of the middle ear nearly always preceded by an URTI.

3 Causes Organisms in children include viruses (min. 25%), Haemophilus influenzae (25%), Moraxella catarrhalis(15%), Streptococcus pneumoniae (25%) and Staphlococcus aureus (2%). Organisms in children include viruses (min. 25%), Haemophilus influenzae (25%), Moraxella catarrhalis(15%), Streptococcus pneumoniae (25%) and Staphlococcus aureus (2%). Organisms in adults include viruses most commonly. Organisms in adults include viruses most commonly. The term recurrent is defined as 3 or more episodes in 6 months, or 4 or more in a year. The term recurrent is defined as 3 or more episodes in 6 months, or 4 or more in a year.

4 Incidence Approximately 40% of children suffer one or more episodes before the age of 10 years. More cases are seen in the winter months. Approximately 40% of children suffer one or more episodes before the age of 10 years. More cases are seen in the winter months. Uncommon in adults. Uncommon in adults.

5 Symptoms Pain Pain –Usual onset at night and severe for 12 hrs, then settles and niggles for 3-5 days Discharge can occur (and often relieves pain) Discharge can occur (and often relieves pain) Fever, vomiting and loss of appetite may occur, especially in young children. Fever, vomiting and loss of appetite may occur, especially in young children. Occasionally tinnitus, voice resonance, giddiness and sickness occur. Occasionally tinnitus, voice resonance, giddiness and sickness occur. Irritability may be the only indication in infants. Irritability may be the only indication in infants. Hearing loss occurs if accumulation of fluid has taken place. Hearing loss occurs if accumulation of fluid has taken place.

6 Signs change of colour of the tympanic membrane to pink/red change of colour of the tympanic membrane to pink/red bulging drum bulging drum loss of outline of drum and landmarks loss of outline of drum and landmarks discharge in meatus discharge in meatus perforation. perforation. there may be tenderness over the mastoid. there may be tenderness over the mastoid.

7 Risk Factors Passive smoker Passive smoker Male Male Family history of otitis media. Family history of otitis media. In day care In day care On formula feed On formula feed

8 Differential Diagnosis Furuncle or diffuse otitis externa Furuncle or diffuse otitis externa Post auricular adenitis Post auricular adenitis Referred otalgia (eg from teeth) Referred otalgia (eg from teeth) Herpetic lesion of ear Herpetic lesion of ear

9 What can go wrong? Progression to glue ear or perforation. Rarely to mastoiditis, labyrinthitis, meningitis, intracranial sepsis or facial nerve palsy. Progression to glue ear or perforation. Rarely to mastoiditis, labyrinthitis, meningitis, intracranial sepsis or facial nerve palsy. Recurrent episodes may lead to atrophy and scarring of the eardrum, chronic perforation and otorrhoea, cholesteatoma, permanent hearing loss, chronic mastoiditis and intracranial sepsis. Recurrent episodes may lead to atrophy and scarring of the eardrum, chronic perforation and otorrhoea, cholesteatoma, permanent hearing loss, chronic mastoiditis and intracranial sepsis.

10 Treatment 80% will resolve within 3 days without treatment, 95% in 5 days 80% will resolve within 3 days without treatment, 95% in 5 days Antibiotics may improve short term symptoms, although evidence for any gain in medium to long term outcome is lacking Antibiotics may improve short term symptoms, although evidence for any gain in medium to long term outcome is lacking Countries with lower rates of antibiotic prescribing for acute otitis media do not have an increase in the number of complications Countries with lower rates of antibiotic prescribing for acute otitis media do not have an increase in the number of complications The Standing Medical Advisory Committee concluded that 'antibiotics are probably unnecessary in acute otitis media. Reassurance, time and adequate pain relief are required.' The Standing Medical Advisory Committee concluded that 'antibiotics are probably unnecessary in acute otitis media. Reassurance, time and adequate pain relief are required.'

11 Treatment Simple analgesia Simple analgesia –Paracetamol –Ibuprofen (some evidence superior) There are no published controlled trials to support the use of antihistamine and decongestant preparations. There are no published controlled trials to support the use of antihistamine and decongestant preparations.

12 Antibiotic Treatment (if chosen) Children and Adults Children and Adults –Amoxycillin limited to three days [SMAC 1998] In patients with penicillin allergy In patients with penicillin allergy –Clarithromycin or azithromycin are both effective and are active against the common pathogen H influenzae. –Erythromycin may be useful, although it lacks activity against H. influenzae


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