Otitis media

Overview

• Definition: Inflammation or infection of the middle ear cavity.

Classification

• Acute Otitis Media (AOM): Rapid onset of symptoms due to bacterial or viral infection.
• Otitis Media with Effusion (OME): Presence of fluid in the middle ear without signs of acute inflammation. Also known as “glue ear”.
• Chronic Suppurative Otitis Media (CSOM): Persistent ear discharge through a perforated tympanic membrane.

Aetiology/ Risk Factors

• Upper respiratory tract infections.
• Eustachian tube dysfunction.
• Age: Common in children.
• Daycare attendance.
• Passive smoking.

Clinical Features

• AOM: Ear pain, reduced hearing, fever, irritability in children.
• OME: Muffled hearing, balance problems, behavioural changes in children.
• CSOM: Persistent ear discharge, hearing loss.

Investigations

• Otoscopy: Bulging or retracted eardrum, effusion, perforation, or pus.
• Audiometry: To assess the level of hearing loss.
• Tympanometry: To assess eardrum mobility.

Management

• AOM: Analgesia (e.g., paracetamol), antibiotics (e.g., amoxicillin) for severe cases or lack of improvement.
• OME: Observation, hearing aids if persistent. Surgical intervention (e.g., grommet insertion) for long-standing cases.
• CSOM: Keep ear dry, topical antibiotics, surgical repair for persistent perforations.

Complications

• Mastoiditis: Infection of the mastoid bone.
• Temporal lobe abscess.
• Chronic hearing loss.

Key Points

• Otitis media is common, especially in children.
• Always assess for complications, especially in AOM.
• OME can lead to speech and developmental delays in children.