Ear Conditions: Acute Otitis Media

exp date isn't null, but text field is

Clinical Description

This is an infection of the middle ear, which communicates with the throat. It is important in a febrile child to look for it and treat it. If persists for more than 72 hours, then start antibiotics. If it does not resolve for a further 72 hours, then, refer. Tropical medicine treatment is ineffective and should be avoided.

Acute otitis media is often viral in origin and needs only a simple analgesic for pain
Clinical Features

SYMPTOMS AND SIGNS:

  • Fever in about 50% of patients, sudden persistent ear pain or pus discharge for < 2 weeks
  • Red eardrum
  • Occasionally inflamed throat
  • Perforated eardrum

INVESTIGATION

  • FBC
  • Ear swab for culture and sensitivity

Treatment:

PHARMACOLOGICAL

  • Give Amoxicillin 15 mg/kg every 8 hourly for 5 days

Alternatively:

  • Give Erythromycin 6.25 mg/kg every 8 hourly or Azithromycin 10mg/kg stat then 5mg/kg q24h for total maximum 5 days for patients with penicillin allergy
  • Give Analgesia as required

 

CHRONIC SUPERLATIVE OTITIS MEDIA

This is a chronic infection of the middle ear with perforation of the tympanic membrane and pus discharging from the ear for more than 2 weeks.

Clinical Features

SYMPTOMS AND SIGNS:

  • Persistent pus discharge, hearing loss
  • If the eardrum has been ruptured for over 2 weeks, secondary infection with multiple organisms usually occurs.
  • Common in immunosuppressed patients
  • This makes oral antibiotic therapy much less effective.

INVESTIGATION

  • Ear swab for culture and sensitivity

Treatment 

NON-PHARMACOLOGICAL

  • Ensure ear is always dry by dry wicking with cotton wool.

A chronically draining ear can only heal if it is dry. Drying the ear is time consuming for both the health worker and the mother, but it is the only effective measure.

  • The mainstay of treatment is topical therapy with Ciprofloxacin ear drops 6 hourly for 5 days
  • Demonstrate/explain carefully to the patient (or guardian in the case of a child) how to dry the ear by wicking (see below)
  • Refer for further assessment if no improvement after 3-4 weeks’ therapy

Dry the ear by wicking.

  1. Roll a piece of clean absorbent cloth or cotton wool into a wick and insert carefully into the patient’s ear.
  2. Leave for one minute
  3. Remove and replace with a clean wick
  4. Watch the patient/guardian repeat this until the wick is dry when removed.
  5. The patient/guardian should dry the ear by wicking at home at least four times daily until the wick stays dry.
  6. If bleeding occurs, temporarily stop drying the ear.
  7. Do not leave anything in the ear between treatments
  8. Commercially made ear buds should be avoided in cleaning the ear.
  9. The patient should avoid swimming or otherwise getting the inside of the ear wet.
  10. Re-assess weekly to ensure that the patient/guardian is drying the ear correctly.
  11. Check for mastoiditis.

Note: TB is an important cause of a chronically discharging ear in Malawi, condition is common in HIV infected children.