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Lawrence Pike
Definition
Inflammation of the middle ear
Causes
Organisms in children include viruses (min.
Incidence
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.
Symptoms
Pain
Usual onset at night and severe for 12 hrs, then settles
and niggles for 3-5 days
Signs
change of colour of the tympanic
membrane to pink/red
bulging drum
loss of outline of drum and landmarks
discharge in meatus
perforation.
there may be tenderness over the
mastoid.
Risk Factors
Passive smoker
Male
Family history of otitis media.
In day care
On formula feed
Differential Diagnosis
Furuncle or diffuse otitis externa
Post auricular adenitis
Referred otalgia (eg from teeth)
Herpetic lesion of ear
Treatment
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
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.'
Treatment
Simple analgesia
Paracetamol
Ibuprofen (some evidence superior)