Otitis Media

Middle ear inflammation

Acute otitis media (AOM): rapid-onset infection, typically post-viral URTI with secondary bacterial infection (S. pneumoniae, H. influenzae, Moraxella catarrhalis), most common in young children (Eustachian tube immaturity).

Otitis media with effusion (OME/"glue ear"): fluid without acute infection signs, often post-AOM.

Chronic suppurative otitis media: persistent perforation with discharge >6 weeks.

• AOM: ear pain (infants; ear tugging, irritability, poor feeding), fever, reduced hearing, discharge if perforated (pain relief often follows perforation). Otoscopy: bulging, erythematous, opacified tympanic membrane, loss of light reflex, reduced mobility on pneumatic otoscopy

• OME: hearing loss/reduced attention/speech delay in children, often minimally symptomatic otherwise, dull retracted TM, air-fluid level/bubbles visible

• Chronic suppurative: persistent/recurrent discharge, conductive hearing loss, visible perforation

• Complications: mastoiditis (postauricular swelling/erythema/tenderness, pinna displaced), facial nerve palsy, intracranial extension (meningitis, abscess ; rare but serious), labyrinthitis

Clinical otoscopy: bulging TM most specific for AOM. Pneumatic otoscopy/tympanometry: assesses mobility, supports OME diagnosis.

Audiometry: for persistent OME (>3 months) affecting hearing/development. CT: if mastoiditis/intracranial complication suspected.

Differentials: otitis externa (tragal tenderness, normal TM), referred pain (dental, TMJ, pharyngitis), foreign body, cholesteatoma (chronic, foul discharge, retraction pocket/keratin debris).

• AOM: many resolve spontaneously ; analgesia (paracetamol/ibuprofen) first-line; delayed/watchful waiting antibiotic prescription reasonable for mild disease age >2 without red flags

• Antibiotics indicated for: age <2 with bilateral AOM, otorrhea, systemic illness, or symptoms not improving at 48-72h: amoxicillin 500mg-1g tds (child: 40-90mg/kg/day divided) × 5-7 days; co-amoxiclav if recent antibiotic failure/amoxicillin-resistant risk

• OME: watchful waiting 3 months : most resolve spontaneously; hearing/speech assessment if persistent; grommet insertion if persistent bilateral OME with significant hearing loss/developmental impact

• Chronic suppurative: aural toilet, topical antibiotic drops (ciprofloxacin, avoid ototoxic aminoglycosides with perforation), keep ear dry; surgical repair (myringoplasty/tympanoplasty) for persistent perforation

• Mastoiditis/intracranial complication (EMERGENCY): admission, IV antibiotics, urgent ENT, imaging, surgical drainage if abscess/not responding

Referral: ENT for recurrent AOM (≥3 episodes/6 months or ≥4/year), persistent OME with hearing/developmental concern, chronic suppurative otitis media, suspected complications (emergency).