otitis media

Last edited 11/2020 and last reviewed 03/2022

• is an inflammation of the middle ear, sometimes associated with upper respiratory tract infection.
• it can be classified as follows:
  • acute suppurative
  • chronic suppurative
  • serous / secretory
    
    
• acute suppurative otitis media
  • may be caused by viral or bacterial infections, or bacterial infection complicating a viral illness,
  • it causes ear pain and tenderness
    
    
• chronic suppurative otitis media
  • manifests as persistent drainage from the ear associated with tympanic membrane perforation and some degree of conductive hearing loss. Chronic ear
  conditions are not usually painful
  
  
• serous or secretory otitis media
  • refers to non-suppurative fluid accumulation in the middle ear
  • this condition is frequently associated with dysfunction or obstruction of the eustachian tube, such as may result from tonsillar hyperplasia or recurrent infection
  • this condition is an important cause of hearing problems in children.
  • in adults, a unilateral serous effusion may be due to a nasopharyngeal tumour which should be excluded

A review concluded that (1):

• suspect acute otitis media in children with ear pain (ear symptoms can be subtle especially in young pre-verbal children), with or without fever


• the presence of middle ear effusion on otoscopy is a prerequisite for diagnosis of acute otitis media
  
  
• antibiotic treatment
• offer oral antibiotics to children with acute otitis media who are systemically unwell and to those at high risk of complications because of pre-existing comorbidity
• oral antibiotics can be considered in children under 2 with bilateral acute otitis media and in children of any age with acute otitis media and acute ear discharge a spontaneous rupture of the eardrum

Reference:

• Venekamp RA et al. Acute otitis media in children.BMJ 2020;371:m4238 http://dx.doi.org/10.1136/bmj.m4238