Transcript Otitis Media - Bradfordvts

Otitis Media
Lawrence Pike
Definition
• Inflammation of the middle ear nearly
always preceded by an URTI.
Causes
• Organisms in children include viruses (min.
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25%), Haemophilus influenzae (25%), Moraxella
catarrhalis(15%), Streptococcus pneumoniae
(25%) and Staphlococcus aureus (2%).
Organisms in adults include viruses most
commonly.
The term recurrent is defined as 3 or more
episodes in 6 months, or 4 or more in a year.
Incidence
• Approximately 40% of children suffer one
or more episodes before the age of 10
years. More cases are seen in the winter
months.
• Uncommon in adults.
Symptoms
• Pain
– Usual onset at night and severe for 12 hrs, then settles and
niggles for 3-5 days
• Discharge can occur (and often relieves pain)
• Fever, vomiting and loss of appetite may occur, especially
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in young children.
Occasionally tinnitus, voice resonance, giddiness and
sickness occur.
Irritability may be the only indication in infants.
Hearing loss occurs if accumulation of fluid has taken
place.
Signs
• change of colour of the tympanic
membrane to pink/red
• bulging drum
• loss of outline of drum and landmarks
• discharge in meatus
• perforation.
• there may be tenderness over the
mastoid.
Risk Factors
• Passive smoker
• Male
• Family history of otitis media.
• In day care
• On formula feed
Differential Diagnosis
• Furuncle or diffuse otitis externa
• Post auricular adenitis
• Referred otalgia (eg from teeth)
• Herpetic lesion of ear
What can go wrong?
• Progression to glue ear or perforation. Rarely to
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mastoiditis, labyrinthitis, meningitis, intracranial
sepsis or facial nerve palsy.
Recurrent episodes may lead to atrophy and
scarring of the eardrum, chronic perforation and
otorrhoea, cholesteatoma, permanent hearing
loss, chronic mastoiditis and intracranial sepsis.
Treatment
• 80% will resolve within 3 days without treatment, 95%
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in 5 days
Antibiotics may improve short term symptoms, although
evidence for any gain in medium to long term outcome
is lacking
Countries with lower rates of antibiotic prescribing for
acute otitis media do not have an increase in the number
of complications
The Standing Medical Advisory Committee concluded
that 'antibiotics are probably unnecessary in acute otitis
media. Reassurance, time and adequate pain relief are
required.'
Treatment
• Simple analgesia
– Paracetamol
– Ibuprofen (some evidence superior)
• There are no published controlled trials to
support the use of antihistamine and
decongestant preparations.
Antibiotic Treatment (if chosen)
• Children and Adults
– Amoxycillin limited to three days [SMAC 1998]
• In patients with penicillin allergy
– Clarithromycin or azithromycin are both
effective and are active against the common
pathogen H influenzae.
– Erythromycin may be useful, although it lacks
activity against H. influenzae