Ear - Otitis Media (Suppurative)
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An acute or chronic infection of the middle ear occurring mostly in children <2years
Cause
- Bacterial infection, e.g., Streptococcus pneumoniae, Haemophilus influenzae
- Commonly follows an acute infection of the upper respiratory tract
Clinical features
- Acute onset of pain in the ear, redness of the ear drum
- Fever
- Pus discharge for <14 days
- Bulging of the eardrum
In chronic otitis media
- On and off pus discharge from one or both ears for >14 days
- No systemic symptoms
Differential diagnosis
- Foreign body in the ear
- Otitis externa and media with effusion
- Referred ear pain, e.g. from toothache
Investigations
- Good history and physical examination are important in making a diagnosis
- Pus swab for microscopy, C&S
ManagementTreatment
Acute infection
- Amoxicillin 500 mg every 8 hours for 5 days
- Child: 15 mg/kg per dose
- Or erythromycin 500 mg every 6 hours in penicillin allergy
- Child: 10-15 mg/kg per dose
- Give analgesics, e.g. Paracetamol as required
- Review after 5 days
Chronic infection
- Systemic antibiotics are NOT recommended: they are not useful and can create resistance
- Aural irrigation 2-3 times a day
- 1 spoon of hydrogen peroxide in ½ glass of clean lukewarm water
- Gently irrigate ear using a syringe without needle
- Avoid directing the flow towards the tympanic membrane
- Dry by wicking 3 times daily for several weeks, until the ear stays dry
- Each time after drying, apply 2-4 drops of ciprofloxacin ear drops 0.5% into the ear
- Do NOT allow water to enter the ear
Note: Refer if complications occur, e.g., meningitis, mastoid abscess (behind the ear), infection in adjacent areas, e.g., tonsils, nose
Prevention
- Health education, e.g. advising patients on recognizing the discharge of otitis media (believed by some to be “milk in the ear”)
- Early diagnosis and treatment of acute otitis media and upper respiratory tract infections
- Treat infections in adjacent area, e.g. tonsillitis