Nachinab Gilbert

 Inflammation of the middle ear nearly always

preceded by an URTI.

 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.
 Organisms in children include viruses (min.
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.
 Passive smoker
 Family history of otitis media
 In day care
 On formula feed
:
 Acute OM (AOM)
 OM with effusion (OME)
 Chronic suppurative OM
 Adhesive OM
AOM implies rapid onset of disease associated
with one or more of the following symptoms:
 Otalgia
 Otorrhea
 Headache
 Fever
 Irritability
 Loss of appetite
 Vomiting
 Diarrhoea
OME often follows an episode of AOM.
Symptoms that may be indicative of OME
include the following:
 Hearing loss
 Tinnitus
 Vertigo
 Otalgia
 80% will resolve within 3 days without treatment,
95% 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.'
 Simple analgesia
◦ Paracetamol
◦ Ibuprofen (some evidence superior)

 There are no published controlled trials to

support the use of antihistamine and
decongestant preparations.
 Children and Adults
◦ Amoxycillin limited to three days

 In patients with penicillin allergy

Clarithromycin or azithromycin are both

effective and active against the common
pathogen H influenzae

Erythromycin may be useful, although it

lacks activity against H. influenzae
 Have the patient sit up, raise head on pillows, or
lie on unaffected ear

 Apply heating pad or a warm hot water bottle

 Encourage breastfeeding of infants as

breastfeeding affords natural immunity to
infectious agents

 Teach family members to cover mouths and

noses when sneezing or coughing and to wash
hands frequently
 Assess hearing ability frequently.