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).

Stunting

Stunting is impaired linear growth, defined as height for age Z score below minus 2 relative to WHO growth standards. Severe stunting is below minus 3.

It reflects chronic or recurrent nutritional deprivation, infection and adverse environmental exposures rather than acute weight loss.

Stunting during the first 1000 days of life is particularly important because it is associated with impaired neurodevelopment, reduced educational performance and long term metabolic consequences.

The child is short for chronological age, often without the striking wasted appearance seen in acute malnutrition.

Associated findings may include:

• Poor developmental progress
• Recurrent infection
• Micronutrient deficiency
• Delayed motor development
• Low weight if wasting coexists

Markedly disproportionate short stature, dysmorphic features or preserved or increased weight despite poor height gain should trigger assessment for genetic, endocrine or skeletal disease.

• Measure recumbent length below 2 years and standing height thereafter.

• Plot height for age using WHO standards.

• Assess parental heights, birth history, growth trajectory and nutrition.

• Evaluate for chronic gastrointestinal, cardiac, renal, infectious or endocrine disease where indicated.

• Consider thyroid function, coeliac serology, FBC, renal function and other investigations when growth pattern is not readily explained nutritionally.

• Improve diet quality, protein and energy adequacy rather than focusing on one isolated nutrient.

• Continue breastfeeding and age appropriate complementary feeding.

• Treat chronic infection, diarrhoeal disease, parasitic disease and micronutrient deficiencies.

• Address environmental contributors including recurrent infection and poor sanitation.

• Children with severe or unexplained stunting require assessment for chronic medical disease and developmental consequences.

Otitis Media

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management