Acute Otitis Media
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Introduction
- Acute inflammation of the middle ear due to pyogenic organisms
Epidemiology
- Common in infants and young children
- More frequent during winter and rainy periods
Aetiology
- Organisms are usually Streptococcus pneumococcus and Staphylococcus aureus
Clinical features
- Earache
- Fever
- Deafness
- Ear discharge
- Malaise (in babies, irritability)
- Redness of the eardrum
- Later, perforation and pulsating mucopurulent discharge
Differential diagnoses
- Acute otitis externa
- Referred otalgia
- Otitis media with effusion
Complications
- Acute mastoiditis
- Facial nerve paralysis
- Labyrinthitis
- Intracranial (Meningitis, Brain abscesses, lateral sinus thrombosis)
Investigations
- Ear swab for MCS- swab taken properly without contamination
- FBC and differentials
Treatment goals
- Control infection
- Restore normal hearing
Non-drug treatment
- Ear toileting and antiseptic dressings
- Myringotomy for persistent mucopurulent collection in middle ear with bulging eardrum
Drug treatment
Antibiotics
- Amoxicillin
- Adult: 500 mg -1 g orally 8 hourly for 5 - 7 days
- Child: 40 mg/kg orally 8 hourly
Analgesics
- Paracetamol
- Adult: 500 mg - 1 g orally 4 - 6 hourly (maximum of 4 g/d) for 5 - 7 days
- Child
- over 50 kg: same as adult dosing
- 6 - 12 years: 250-500 mg 4-6 hourly
- 1 - 5 years: 125 - 250 mg
- 3 months - 1 year: 125 - 250 mg for 5 - 7 days
Systemic decongestant
- Psuedoephedrine
- Adult: 60 mg orally 4 – 6 hourly, (maximum 4 times a day)
- Child:
- 6-12 years: 30 mg (5 mL of syrup) 8 hourly;
- 2-5 years:15 mg, (2.5 mL of syrup) 4-8 hourly
Supportive measures
- Bed rest and adequate fluids
Notable adverse drug reactions, contraindications, and, caution
- Preparations of pseudoephedrine with antihistamines may cause drowsiness
- Avoid ear drops
Prevention
- Good general health and clean airy environment to reduce incidence of upper respiratory infections (colds)