Otitis Media (Suppurative)

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ICD10 CODE: H66

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

Management

Treatment	LOC
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	HC2
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	HC3
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