acute otitis media: overview, risk factors, symptoms & treatment
overview of acute otitis media
- acute otitis media is a condition in which there is inflammation of the middle ear lasting 3weeks. It is a term which describes two conditions which form part of a continuum of disease.viz:
- Acute otitis media (AOM)
- otitis media with effusion (OME). Both occur mainly in childhood.
- The most common affliction necessitating medical therapy for children younger than 5 years
- It is frequently in association with an upper respiratory tract infection (URTI).
- The peak incidence of AOM is in children aged 3-18 months.
children are affected most with acute otitis media
- Most children will experience some form of acute otitis media during their lifetime:
- The peak age of incidence is 3 months to 18 months old and it is rarely seen above 5 years of age.
- The incidence is slightly higher in boys than in girls.
- Otitis media occurs more in the winter and rainy months as it is usually associated with a cold.
- It can occur in adults but this is most unusual.
RISK FACTORS
which of the children are at risk of otitis media?
The following, attribute, characteristic or exposure may increase the likelihood of acute otitis media in your child .
- Prematurity and low birth weight
- Young age
- Early onset
- Family history-genetic
- Race – Native American, Inuit, Australian aborigine
- Altered immunity
- Craniofacial abnormalities
- Neuromuscular disease
- Allergy
- Day care
- Crowded living conditions
- Low socioeconomic status
- Tobacco and pollutant exposure
- Use of pacifier
- GENDER;
- FORCED FEEDING;
- FEEDING WHILE LYING DOWN
- Fall or winter season
- Absence of breastfeeding, prolonged bottle use
clinical symptoms of acute otitis media
- Neonates: Irritability or feeding difficulties may be the only indication of a septic focus
- Older children: This age group begins to demonstrate a consistent presence of fever and pain, or ear tugging
- Older children and adults: Hearing loss becomes a constant feature of AOM and otitis media with effusion (OME); ear stuffiness is noted before the detection of middle ear fluid
- ear discharge which may be smelly
- ear pain without hearing loss or fever is observed in adults with external otitis media, dental abscess, or pain referred from the temporomandibular joint. Orthodontic appliances often elicit referred pain as the dental occlusion is altered
signs
- Fever may be very high.
- Tragal tenderness
how is acute otitis media diagnosed?
Otoscopy
Your child’s doctor will use an instrument called an otoscope to look into the ear of his/her ear and will detect:
- Redness (infection/inflammation)
- bulging eardrum (swelling)
- blood or pus
- Immobile tympanic membrane (effusion)
- Perforated tympanic membrane
- Pain
- Hearing loss is present but not usually noticed in an acutely unwell child.
- swelling at the back of the ear
tympanometry
Here your child’s doctor uses a small instrument to measure the air in your babies ear and determine if the eardrum is ruptured.
hearing test
the doctor may perform a hearing test to determine if your child is expriencing hearing loss.
differential diagnosis
other diseases that may have similar symptoms as acute otitis media
- Otitis externa (OE)
- Post-auricular adenitis
- Referred pain (especially from teeth)
- Herpetic infection of ear
- Foreign body in external canal
investigations to confirm diagnosis
Tympanocentesis- sample is taken from the ear for microscopy, culture and sensitivity in other to pick out the causative organism.
- Tympanocentesis should be performed in the following patients with AOM:
- Neonates who are younger than 6 weeks (and therefore are more likely to have an unusual or more invasive pathogen)
- Immunosuppressed or immunocompromised patients
- Patients in whom adequate antimicrobial treatment has failed and who continue to show signs of local or systemic sepsis
- Patients with a complication that requires a culture for adequate therapy
Radiological imaging-for complications-CT, MRI
- TREATMENTS
how is acute otitis media treated?
It could be medical i.e. with the use of drugs or surgical
- MEDICAL
- Analgesics-ibuprofen, paracetamol
- 2% lignocaine ear drops
- Decongestants
- Antibiotics e.g. Amoxicillin
- Amoxicillin/clavulanate
- Erythromycin base/sulfisoxazole
- Trimethoprim-sulfamethoxazole
- Cefixime
- Cefuroxime axetil etc.
- SURGICAL
- Tympanocentesis
- Myringotomy
- Myringotomy with insertion of a ventilating tube(grommet)
complications of acute otitis media
- Most cases of AOM will resolve spontaneously with no sequelae.
- hearing loss
- recurrent ear infections
- Perforation of the eardrum is common and progression to chronic suppurative otitis media may occur.
- Labyrinthitis, meningitis, intracranial sepsis or facial nerve palsy are very rare’
- Febrile convulsion and cholesteatoma.
prognosis
- Good with good antibiotics.
prevention of acute otitis media
- breast feed infants instead of bottle feeding
- wash your hands before feeding your child
- daily inspection of your babies ear
- avoid forced feeding
- do not use pacifiers
- wash babies toys
- avoid cigarette smoking
- minimize use of crowded areas like creches
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