Otitis media
| Expectant management may be appropriate for mild cases. Effusion can persist for weeks-months after initial infection. |
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|---|---|
| Etiology | H. flu, S. pneumoniae, Moraxella. |
| Epidemiology | More common in kids; acute otitis media = 6-18 months. May be complication of Measles |
| Clinical presentation | otalgia, URTI s/s, no discharge (pain gets better if perforated - 'pop') otoscopy: bulging/cloudy tympanic membrane, ± perforation Diagnostic criteria = ALL of: 1. Acute onset (<48 hours) of signs and symptoms 2. Middle ear effusion (MEE) 3. Signs and symptoms of middle ear inflammation (fever, otalgia, irritability in an infant; red tympanic membrane not due to crying or fever) |
| Pathogenesis | |
| Diagnostic investigations | |
| Management | Otitis media with effusion may persist after acute infection Acute otitis media: analgesia + observe 2-3d ➥ Disease should improve in 72h ➥ If abx needed: 5-7d amox/clari (erythro in pregnancy) ➥ Treatment failure with amox: consider complications, resistance → 1o care f/up 2/52 ➥ Chronic: prophylact with trimethoprim 6/52 ➥ Immediate abx if age <3m or <6m + fever; Complications are rare. (NNT to prevent mastoiditis for example is about 5000!) >> mastoiditis (OM of temporal bone → periosteal abscess in mastoid air cells)+/- intracranial extension >> facial nerve palsy >> conductive deafness after persistent effusion |
decision for abx:
- All infants under 6 months
- Age 6 months – 2 years with a certain diagnosis or an uncertain diagnosis and severe illness - i.e. systemic s/s
- Age 2 years and over with a certain diagnosis and moderate/severe illness**
Cochrane review (Venekamp et al 2023) found that antibiotics have
- no effect on pain in the first 24 hours and only a slight effect in the days following
- risk of side effects