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Detailed information of OTITIS MEDIA
OTITIS MEDIA
DEFINITION:
Infection of the middle ear.
EPIDEMIOLOGY:
- incidence: ?
- age of onset:
- risk factors:
- craniofacial malformations
- congenital disorders
PATHOGENESIS:
- painful middle ear infection associated with toxicity
- natural history of untreated cases
- otalgia with fever +/- toxicity lasts from hours to
2-3 days then the tympanic membrane ruptures spontaneously
with the symptoms disappearing - ear discharges pus
through a small hole for 3 days which then closes and
heals over - the remaining middle ear effusion disperses
down the eustachian tube over the next 3 months
2. Otits Media with Effusion (OME)
- painless middle ear infection not associated with
toxicity
- also called chronic serous otitis media
- may be acute (<3 weeks), subacute (3 weeks-3 months), or
chronic (>3 months)
2. Organisms (% of cases)
CLINICAL FEATURES:
- rapid onset of ear pain (otalgia) with fever +/-
- rapid onset of purulent discharge through a tympanotomy
tube
- longstanding tympanic membrane perforation
2. Signs
- erythematous and opaque tympanic membrane ™
- TM immobile on pneumatic otoscopy
3. Complications (in 5-15% of untreated cases)
- acute labyrinthitis
- acute mastoiditis
- acute meningitis
- lateral sinus thrombosis
- persistent TM perforation
- temperal lobe abscesses
2. Otitis Media with Effusion
- feeling of fullness in the ears (plugged) but painless
2. Signs
- TM red, yellow, white, purple, and/or opaque
- TM immobile on pneumatic otoscopy
- effusion may be serous, mucoid, or purulent
INVESTIGATIONS:
- see file on "Hearing Loss"
- Behavioural Observational Audiometry (BOA)
- Tympanometry (Impedance Audiometry)
- Brainstem Auditory-Evoked Responses (BAER)
MANAGEMENT:
- 85-95% of OM will resolve spontaneously without treatment
but there is an increased incidence of complications if no
medications are used
- tylenol 15 mg/kg/dose q4h prn for analgesia
- cleaning out of ear wax
- 5 capsules of colace powder (100 mg/capsule) into 45 cc of
normal saline; 3 drops in each ear tid x 3 days
2. Antibiotics
- 25 mg/kg/day po tid
- 10-15% of organisms will be resistant to amoxil
2. Trimethoprim-Sulfamethoxazole (Septra)
- 6 mg trimethoprim/kg/day + 30 mg sulfamethoxazole/kg/day
po bid
- ineffective against Strep. pyogenes
- side effects: blood dyscrasias, aplastic anemia due to
sulfa component
3. Amoxicillin/Clavulanate (Clavulin)
- 50 mg/kg/day po tid
- side effects: diarrhea
4. Erythromycin Ethylsuccinate-Sulfisoxazole Acetyl (Pediazole)
- 50 mg/kg/day (erythromycin component) po qid
- side effects: blood dyscrasias, aplastic anemia due to
sulfa component
5. Topical Antibiotics
- topical corticosteroid + gentamicin
- 3-4 drops into affected ear tid as long as discharge is
present
- indications: discharging tympanotomy tube, permanent
tympanic membrane perforation
3. Acute OM
- antibiotic x 10 days with follow-up in 3 weeks if
asymptomatic or after 72 hours if remains symptomatic
- most children will still have a middle ear effusion after 10
days of therapy and 20% still have an effusion 2 weeks after the
initiation of therapy; it may take 3 months for some effusions
to clear
4. Recurrent AOM
- antibiotic therapy as above with each attack treated as if
it were the first
2. Less Than 2 Months Apart
- prophylactic antibiotics (use also if there are more than
3 attacks in a 6 month period):
- if an AOM develops during prophylactic therapy,
discontinue the prophylactic antibiotic and switch to another
anti-biotic at full strength, treat for 10 days, then resume
prophylaxis
5. Surgery
- indications for:
- recurrent AOM and have failed prophylaxis
- chronic OME (lasting >3 months) with hearing loss
2. Adenoidectomy
- indications for:
- if tympanotomy tubes are required for a 3rd or 4th time
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