Acute Otitis Media
Acute ear infection occurs with up to 30 percent of URIs.
Infants and young children are prone to acute otitis media, most common at 6-12 months of age (horizontal and short tube)
Etiology:
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Bacteria are the most common pathogens in OM, most frequently as a co-infection with viruses.
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Viruses can be the sole pathogen in OM, but this is less common (<20%).
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Bacteria including Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis.
Clinical Picture
In infants: fever, irritability, and poor feeding.
In older children and adolescents:
- AOM usually is associated with fever and otalgia (acute ear pain).
- AOM also may present with otorrhea (ear drainage) after spontaneous rupture of the tympanic membrane.
- Signs of a common cold, which predisposes to AOM, are often present.
- A bulging tympanic membrane, air fluid level, or visualization of purulent material by otoscopy are reliable signs of infection.
- Examination of the ears is essential for diagnosis.
- The hallmark of OM is the presence of effusion in the middle ear.
Diagnosis
Diagnostic action statements from the AAP guidelines include the following:
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AOM should be diagnosed when there is moderate to severe tympanic membrane bulging or new-onset otorrhea not caused by acute otitis externa.
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AOM may be diagnosed from mild tympanic membrane bulging and ear pain for less than 48 hours or from intense tympanic membrane erythema; in a nonverbal child, ear holding, tugging, or rubbing suggests ear pain.
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AOM should not be diagnosed when pneumatic otoscopy and/or tympanometry do not show middle ear effusion.
Tympanic Membrane Examination:
- Bright red, bulging, loss of light reflection.
Complications:
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It may lead to perforated eardrums and chronic ear discharge in later childhood and ultimately to hearing impairment or deafness.
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Mastoiditis and meningitis (STAT admission & surgery), but uncommon.
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Chronic ear infection following repeated episodes of acute ear infection is common in developing countries, affecting 2 to 6 percent of school-age children.
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The associated hearing loss may be disabling and may affect learning.
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Recurrent ear infections can lead to otitis media with effusion (OME or glue ear or serous otitis media).
Treatment:
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Regular analgesic e.g. Paracetamol, ibuprofen. (every hour to reduce inflammation)
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The recommended first-line therapy for most children meeting the criteria for antibiotic therapy is amoxicillin (80–90 mg/kg/day in two divided doses).
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Some children with mild illness or uncertain diagnosis may be observed if appropriate follow-up within 48–72 hours can be arranged with the initiation of antibiotic therapy if symptoms do not self-resolve.
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Treatment of complications e.g. grommets insertion.
