2DefinitionInflammation of the middle ear nearly always preceded by an URTI.
3CausesOrganisms 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.The term recurrent is defined as 3 or more episodes in 6 months, or 4 or more in a year.
4IncidenceApproximately 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.
5Symptoms Pain Discharge can occur (and often relieves pain) Usual onset at night and severe for 12 hrs, then settles and niggles for 3-5 daysDischarge can occur (and often relieves pain)Fever, vomiting and loss of appetite may occur, especially in young children.Occasionally tinnitus, voice resonance, giddiness and sickness occur.Irritability may be the only indication in infants.Hearing loss occurs if accumulation of fluid has taken place.
6Signs change of colour of the tympanic membrane to pink/red bulging drumloss of outline of drum and landmarksdischarge in meatusperforation.there may be tenderness over the mastoid.
7Risk Factors Passive smoker Male Family history of otitis media. In day careOn formula feed
8Differential Diagnosis Furuncle or diffuse otitis externaPost auricular adenitisReferred otalgia (eg from teeth)Herpetic lesion of ear
9What can go wrong?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.
10Treatment80% will resolve within 3 days without treatment, 95% in 5 daysAntibiotics may improve short term symptoms, although evidence for any gain in medium to long term outcome is lackingCountries with lower rates of antibiotic prescribing for acute otitis media do not have an increase in the number of complicationsThe Standing Medical Advisory Committee concluded that 'antibiotics are probably unnecessary in acute otitis media. Reassurance, time and adequate pain relief are required.'
11Treatment Simple analgesia ParacetamolIbuprofen (some evidence superior)There are no published controlled trials to support the use of antihistamine and decongestant preparations.
12Antibiotic Treatment (if chosen) Children and AdultsAmoxycillin limited to three days [SMAC 1998]In patients with penicillin allergyClarithromycin 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