Otitis Media

Lawrence Pike

Definition
Inflammation of the middle ear

nearly always preceded by an URTI.

Causes
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.
The term recurrent is defined as 3 or more
episodes in 6 months, or 4 or more in a year.

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

Discharge 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.

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

What 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.

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)

There are no published controlled

trials to support the use of
antihistamine and decongestant
preparations.

Antibiotic Treatment (if

chosen)
Children and Adults
Amoxycillin limited to three days [SMAC 1998]

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