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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.

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