Ear ache ….could it be otitis media

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Otitis media is inflammation of the middle ear .It is very common among children and there are four main type. Babies and young children get more middle-ear infections than older children because the tubes (called the Eustachian tubes ) that connect the middle ear to the throat are smaller. This makes it easier for germs to reach the middle ear from the nose and throat during head colds, which are very common in small children.

Those are Acute otitis media , acute suppurative ,chronic otitis media with effusion , and glue ear.

Symptoms of otitis media include ear pain, ear discharge, hearing impairment,tinitus, fever, vomiting , headache, diarrhea , irritability , labirinthitis, facial palsy , intracranial infection suspect.

Conditions  which could be confused with otitis media are otitis externa ,furancle, periodontitis , Mumps , spinal dysfunction , cholesteotoma , upper respiratory tract infection , lower respiratory tract infection dental pain and rumsihan syndrome.

 

Redflags includes offensive ear discharge , high fever , duration more than  9 days , Pinna position downward displacement , Drowsyness  , headache ,mastoid tenderness,  drinking < 2/3 urine UOP < 3 nappy in 24 patient is irritable and  not consolable .

Patient may have associated Eustachian tube dysfunction and they may feel fullness in the ear. It is better to exclude Injury to head , Hit over the ear , Trauma and baro trauma ( any one hit over the ear ).

 

Past history of similar events and exposure to  smoking is other important parts in the history

hearing test  ( Rinners for type , webers for asymmetry ),Internal ear examination – hyperemic, Translucent, Light reflex, fluid in side, position of handle of melius , bulging TM, and Perforation, (Young back elder upward backward) ,Neck stiff ness

Otitis media is unlikely to be present if the tympanic membrane (TM) is mobile. Pneumatic otoscopy greatly assists diagnosis since the most valuable sign of otitis media is absent or diminished motility of the TM.

Swab for culture and ABST, FBE, CRP may be important as primary investigations.

Infection of the outer ear (or auditory canal,) or Otitis Externa are bacterial infections usually due to excess moisture in the canal, eg. after swimming, or damage to the canal after use of cotton buds or scratching.

Mastoditis patients are unwell with systemic signs requires admission  for iv antibiotic, insertion of T Tube and Drainage of subperiosteal abscess and mastedectomy if it is cholesteotoma.

Antibiotics are important in children though commonest cause is viral- amoxicillin15- 90 mg / kg if resistant  Cefaclor or augmenting.

Paracetamol for pain , Anesthetic drops  , Change antibiotics according to Culture.

⃝ Acute Otitis media without perforation ——–< 3 year / recurrent / BL Disease/ high fever   Antibiotics  4 days

> 3 years pain killer + script ( take if not improving in 24- 48 hours, rew in 48 hours ….. If effusion > 3 M refer .

⃝ Otitis media with perforation ————–  Antibiotic  7 days , review in 3 days with culture and then review in 7days  , If mild symptoms Topical antibiotics ( Quinilone ) , Rev 14 days , If still symptoms refer or Topical antibiotics and review in another  2/52……… If perforation persist more than one month patient needs to be referred.

⃝Cronic otitis media with Central perforation – dry moping + Antibiotics ( treat as otitis external if it is  Atic perforation urgent referal in necessary as  cholesteotoma  requires surgical treatments and life long follow up

⃝ Glue ear is treated initially with  bromohexine or exercise to outo inflation of Eustachian tube . If medical treatment unsuccessful  early drainage of the ear ( miringotomy ) with or Without tympanostomy tube may need to be considered  .  If grommet with many discharge treat as otitis externa (ie, ear toileting and topical)
Grommet remove at about 9months if not fall itself.

⃝ Recurrent OM means (3 or more episodes in 6 months or every other months ) Chemopropilaxis for 6 Months ( amoxicillin BD X 4 M + Pneumococcal vaccine + no smoking

After 3 months all patients with chronic type of ear disease needs referral for hearing tests and look for effusion. Children should be followup on school performance and IQ level in the long run.

 

 

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