• inflammation of middle ear and tympanic membrane

• resut of URTI

• generally:

  • viral URTI complicated by 2ary bacterial infection

  • initial infection maybe viral

• very common in children

  • unavoidable illness?

    • natural maturation of child’s immune system

• high rate of sponataneous recovery

  • suppurative complications can occur

    • perforation of TM

    • OE

    • mastoidistis

  • other sequelae

    • balance

    • motor control

    • hearing

• OM

  • AOM

  • OME

Risk factors

• host

  • age

    • 6-24mo

    • 4-5yrs

  • reduced breast feeding

    • at least 3mo reduces rates of AOM by 13%

  • premature birth

  • use of dummy

    • after age 11mo

      • 24% increase

• environmental

  • overcrowded

  • maori/pacific

  • attendance at daycare

  • overcrowding

  • winter

  • passive smoking

acute otitis media

• by age 3yrs

  • 50-85% of children will have had AOM

• rapid onset of pain and/or fever

• most useful symptoms = otalgia

• also symptoms:

  • URTI

  • abnormal ear tugging

  • otorrhoea

  • hearing loss

  • irritability

  • not setlting at night

• otoscopy

  • TM

    • bulge due to effusion with loss of normal landmarks

    • show areas of intense erythema and/or yellow discoloration

    • loss of translucenecy and be dull or opaque

    • display reduced mobility

bulging, opacity and immobility are all highly predictive of AOM

Management

• reassurance

• symptom relief

  • paracetamol

  • ibuprofen

    • not given if dehydrated/asthma

• watchful waiting

  • 80% have spont resoluytion within 2-14d

• antibiotics

  • can reduce symptoms and decrease likelihood of persistent infection

  • considered;

    • \<6mo

    • \<2yo with biltaeral or severe illness

    • AOM and perforation

    • systemic symptoms - fever

    • who have not improved following 48hrs of watchful waiting

  • amoxicillin 40mg in 2-3 divided doses for 5d

    • 7-10d in:

      • child \<2yo

      • underlying medical condition

      • perforated drum

      • chornic/recurrent infections

    • resistant strep pneumo

      • consider 80mg/kg/day

  • erythromycin trialed last as poor activity against Haemophilis influenza

  • back pocket

    • persist 24-48hrs

Otitis media with effusion

• presence of fluid in the middle ear without signs or symptoms of an infection

• can occur spontaneously as part of rhinosinusitis

  • following epside of acute OM

• most fequent cause of balance disorder and acquired conductive hearing loss in children

• following AOM

  • OME 1/2 at 1/12

  • 20% at 2mo

  • 10% at 3mo

• most will improve spontaneously within 3mo

• no causal relationship between OME and peristent hearing loss affecting language development

• diagnosis

  • pneumotic otoscopy or tympanotry shows reduced/absent tympanic membrane mobility

  • abnormal coloring

  • opacity

  • air bubbles

Management

• watchful waiting

• antibiotics provide little or no long-term benefit for children with OME

Tympanometry

• allows assessment of middle ear function by measuring tympanci membrane compliance

• 3 borad traces:

  • A - normal middle ear

  • B - decreased mobility

    • lacks sharp peak

      • presence of fluid

    • cerumen

    • grommets

    • tympanic membrane scarring

    • tympanosclerosis

    • cholesteatoma

    • middle ear tumour

  • C - negative pressure

    • retracted drum

    • eustacian tube dysfunction

    • Left shift

Referral

• recurrent AOM

  • 3 episodes within 6mo

  • 4 episodes in 1 yr

• Grommets

  • reduce incidence of recurrent AOM in 6mo following insertion

• OME with hearing loss >3mo

Choronic suppurative OM

• most severe form of OM

• grommet insertion = significnat cause

• discharge through perforated TM which persists for 3-6wk

  • topical quinolones = first line

  • small risk of ototoxicity with use of non-quinolone

• ciprofloxacin with hydrocortisone (NS) = effective