Otitis Media

Clinical presentation 

• Previous upper respiratory tract infection
• Painful ear
• Restlessness
• Fever
• Hearing often reduced
• Inflamed, bulged tympanic membrane

Non-pharmacological Treatment: 

• Acute  otitis  media  should  be  treated  with  analgesics,  antibiotics  and/or  paracentesis/(Myringotomy) to reduce pain and to obtain pus for culture and sensitivity

Pharmacological Treatment

B: amoxicillin+clavulanic acid (PO) 375–625mg 12hourly for 10days 

OR 

A: azithromycin (PO) 500mg 24 hourly for 5days (for patients who are allergic to penicillin) For 

Children  

A: azithromycin (PO) 10mg/kg 24hourly for 5days 

OR 

B: ceftriaxone (IV) 1 to 2 g    12hourly for 10days. 

For Children: 

B:  ceftriaxone (IV) 50 to 100mg/kg 24hourly for 10days 

OR 

C: clarithromycin (PO) 500mg 12hourly for 10-14days

For Children ≥ 6 months:  

C: clarithromycin (PO) 15mg/kg/day in 2divided doses for 10-14days 

OR 

S: cefixime (PO) 400mg 24hourly for 10-4days 

For Children ≥ 6 months to 12 years (weight below 45kg): 

S: cefixime (PO) 8mg/kg 24hourly for 10-14days 

AND 

A: paracetamol (PO) 500mg to 1g 4-8hourly for 3days. 

For Children ≤ 10kg:  

A: paracetamol (PO) 10mg/kg 4-8hourly for 3days 

For Children >10kg: 

A: paracetamol (PO) 15mg/kg 4-8 hourly for 3days. 

OR 

A: ibuprofen (PO) 200mg to 400mg 4-8hourly as needed. 

For Children ≥ 6 months: 

A: ibuprofen (PO) 5mg to 10mg/kg 4-8hourly as needed 

OR 

C: diclofenac+ paracetamol (PO) 50mg diclofenac and 500mg paracetamol 4-8hourly as needed 

Note: For antibiotics, treatment periods shorter than 10 days increase the risk of treatment failure 

Referral

• Children with high fever, severe ear pain, headache, altered state of consciousness
• A chronically discharging ear that persists in spite of proper treatment
• Foul smelling ear discharge
• Mastoiditis
• Otitis in the normal (or better hearing) ear combined with permanent hearing loss in the other ear

This is a perforated tympanic membrane with persistent drainage from the middle ear for more than  2-6  weeks.  Most  common  causative  organisms  are  Pseudomonas  aeruginosa,  Staphylococcus aureus, Proteus species, Klebsiella pneumonia, and diphtheroids.

Clinical presentation 

• Discharge of pus from the ear
• Perforated tympanic membrane
• Reduced hearing

Non-pharmacological Treatment

• Keep ear dry/avoid water into the ear
• Aural toilet – ear suctioning under direct vision(otomicroscopy/ endoscopy), removal of debris
• Ear wicking regularly, with a dry cotton wick at home

Pharmacological Treatment 

C: ciprofloxacin ear drops, three drops 12hourly for 14days  

A: hydrogen peroxide 3% ear drops: 2 to 4 drops each ear 6-8hourly for 14days 

OR 

A: boric acid ear drops: 2-4 drops each ear 6-8hourly for 14days 

OR 

D: ofloxacin ear drops: 2 to 4 drops each ear 6-8hourly for 14days 

AND 

A: ciprofloxacin (PO) 500mg 12hourly for 10days 

For Children: 

A: ciprofloxacin (PO) 10–20mg/kg 12hourly for 10days 

Surgical management 

• Mastoidectomy
• Endoscopic tympanoplasty
• Tympano-mastoidectomy
• Ossiculoplasty

Note:

• Treatment of shorter than 10 days will result in treatment failure 
• Avoid ototoxic drugs(gentamycin, neomycin and quinine) if there is TM perforation 

It is a multifactorial, inflammatory condition in the middle ear with serous or mucous accumulation without  ear  discharge.  It  is  a  residual  condition  after  acute  otitis  media  and  rhino  sinusitis  with  Eustachian tube dysfunction.  

Diagnostic Criteria 

• It is often discovered by chance
• Little or no ear pain
• Gradual loss of hearing
• No ear discharge
• Aural fullness

Non-pharmacological Treatment

• Close follow-up
• Valsava maneuver
• Encourage chewing

Pharmacological Treatment 

D: fluticasone propionate (50mcg/spray) nasal spray

Adults and adolescents more than 12years: 2sprays in each nostril 24hourly as needed

Children 4-11years: 1spray in each  nostril 24hourly as needed. 

OR 

S:  mometasone  (nasal  spray)  Adults  and  adolescents  from  12years:  1  spray  in  each nostril 24hourly as needed. Children 6-11years: 1spray in each nostril 24hourly as needed 

AND  

B: ephedrine (0.5% and 1%) nasal drop, Adults and children above 12years: Instill 1 to 2 drops in each nostril, not more than 4 times a day for 3 to 5 days 

Note: Otitis  media  with  effusion  with  hearing  loss  that  does  not  improve  after  3months  should  be referred to a specialist for myringotomy and grommets insertion 

Surgical management 

• Myringotomy + grommet insertion (microscopic/endoscopic) + Adenotonsilectomy (in children