Otitis Media
OM
(summarised AMH)
Acute Otitis Media
Hx
Pain
Fever
Irritability
O/e
Fever
Etiology
Viruses
Bacterial (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis)
Complications:
Mastoiditis
Contralateral otitis media
Pain
Rx
Analgesia
- first line paracetamol
- second line ibuprofen
Antibiotics
Rx if ATSI, immunocompromised, fever or vomiting
>2yo, no Rx for 48 hours, review and start if not improving (nb effusion will last for several weeks before resolution)
6m-2yo, no Rx for 24 hours, review and start if not improving
<6m,
Natural history is self resolution 24 hours, effusion resolving after several weeks
Amoxicillin
OR Cefuroxime if NON-anaphylaxis reaction
OR Bactrim if anaphylaxis to penicillins
OR Amoxicillin and clavulanic acid if treatment failure
reduces complications, particularly in at risk
doubles incidence of vomiting, diarrhoea and rash, increased resistance
---
Acute Suppurative Otitis Media
- perforated ear drum and mucopurulent discharge <6w
Rx as for AOM for 10 days
can try acetic acid drops to restore canal pH to prevent otitis externa
(some ENT regs have suggested this + CSOM Rx even when acute)
---
Chronic Suppurative otitis media
- perforated ear drum and mucopurulent discharge >6w
Rx QID ear toilet, ciprofloxacin ear drops (tissue spears do it right website)
P. aeruginosa, E. coli, S. aureus, Proteus mirabilis and Klebsiella
---
Otitis media with effusion (Glue ear)
- fluid behind intact drum without signs of acute infection
- causes hearing and subsequent language impairment
- 90% resolve <3m
- if persistent at 3m >refer for hearing assessment and to ENT for consideration of Grommets
- post tympanostomy, treat discharging tympanostomy tube as CSOM as above
(summarised AMH)
Acute Otitis Media
Hx
Pain
Fever
Irritability
O/e
Fever
Etiology
Viruses
Bacterial (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis)
Complications:
Mastoiditis
Contralateral otitis media
Pain
Rx
Analgesia
- first line paracetamol
- second line ibuprofen
Antibiotics
Rx if ATSI, immunocompromised, fever or vomiting
>2yo, no Rx for 48 hours, review and start if not improving (nb effusion will last for several weeks before resolution)
6m-2yo, no Rx for 24 hours, review and start if not improving
<6m,
Natural history is self resolution 24 hours, effusion resolving after several weeks
Amoxicillin
OR Cefuroxime if NON-anaphylaxis reaction
OR Bactrim if anaphylaxis to penicillins
OR Amoxicillin and clavulanic acid if treatment failure
reduces complications, particularly in at risk
doubles incidence of vomiting, diarrhoea and rash, increased resistance
---
Acute Suppurative Otitis Media
- perforated ear drum and mucopurulent discharge <6w
Rx as for AOM for 10 days
can try acetic acid drops to restore canal pH to prevent otitis externa
(some ENT regs have suggested this + CSOM Rx even when acute)
---
Chronic Suppurative otitis media
- perforated ear drum and mucopurulent discharge >6w
Rx QID ear toilet, ciprofloxacin ear drops (tissue spears do it right website)
P. aeruginosa, E. coli, S. aureus, Proteus mirabilis and Klebsiella
---
Otitis media with effusion (Glue ear)
- fluid behind intact drum without signs of acute infection
- causes hearing and subsequent language impairment
- 90% resolve <3m
- if persistent at 3m >refer for hearing assessment and to ENT for consideration of Grommets
- post tympanostomy, treat discharging tympanostomy tube as CSOM as above