Acute Otitis Media

Acute Otitis Media is the infection and inflammation of the middle ear. Here, a viral URTI causes inflammation of respiratory mucosa → Obstruction of Eustachian tube → Negative middle ear pressure → Fluid accumulation → Microbial growth in fluid w/pus formation. Its causes include:

• Viral - RSV, other viral URTIs

• Bacterial - S. pneumoniae (most common), H. influenzae, M. catarrhalis

Presentation

• Ear pain

• Reduced hearing

• Fever

• Usually preceded by a Viral URTI

• Otorrhoea if perforated tympanic

• O/E

  • Bulging tympanic membrane

  • Erythema

  • Discharge

Management

Most resolve within a week without intervention, so patients' only require supportive management with simple analgesia (paracetamol/ibuprofen). However, if the patient is systemically unwell or their symptoms aren’t improving by itself, an Abx can be prescribed, with the options including Amoxicillin (1st line), Clarithromycin, Erythromycin. This can be presribed as:

• Delayed - To take if patient isn’t improving or are getting worse

• Immediate - Given if patient is systemically unwell or at high risk of complications (e.g. immunocompromised)

N.B. Always safety-net the patient, making sure they know when to seek further medical attention.

Complications

Extra-cranial complications (common):

• Chronic Otitis Media

• Labrynthitis (HL+Vertigo) - Inflammation spreads to semi-circular canals, leading to vestibular dysfunction

• Mastoiditis - Infection spreads to form an abscess in the mastoid air spaces, leading to post-auricular swelling and mastoid tenderness

• Facial nerve palsy

• Petrositis - Infection spreads to apex of petrous temporal bone, leading to otorrhoea, retro-orbital pain, and ipsilateral CN6 palsy

Intra-cranial complications (rare):

• Meningitis - presents with sepsis, headache, vomiting, photophobia and neck stiffness

• Sigmoid sinus thrombosis - presents with sepsis, swinging pyrexia and meningitis

• Brain abscess - presents with sepsis and neurological signs due to cranial nerve compression