What is acute otisis media (AOM)?
Acute otitis media describes rapid onset of inflammation of middle ear, which is of limited duration. the inflammation is thought to be due to acute infection (viral or bacterial) that may give rise to local and/ or systemic symptoms. It is one of the most common childhood conditions seen in primary care.
What are the important factors associated with AOM?
AOM os most common in early childhood, especially in the first 6 years of life. Other associated factors include:
• Preceding upper respiratory tract infection. Any resulting effusion in the middle ear provides a culture medium for bacteria- the most common being Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. as the bacteria multiply, the effusion will become mucopurulent causing the tympanic membrane to bulge. This may progress o spontaneous perforation of the tympnic membrane followed by purulent otorrhoea.
• Regular contact with many other children (e. g. at nursery)
• Adenoidal hypertrophy
• Seasonal climate (more prevalent in the autumn and winter)
• Use of dummies
• Living in a smoking households
What are th typical features and symptoms of AOM?
Children with AOM usually have features of a preceding URTI that disguises any ear problems. Younger children are unable to express themselves clearly, and may not localise symptoms to the ears. symptoms are notoriously poorly sensitive and specific. It is not surprising then, that AOM is often missed or over-diagnosed.
Local symptoms may include earache, rubbing/ tugging at the ear, decreased hearing, and muco-sangnous discharge (usually accompanied with a relief from the pain as the tympanic membrane ruptures with a release of the muco-pus).
Systemic symptoms include fever, loss of appetite, nausea, vomiting, persistent crying, irritability and disturbed sleep.
How should AOM be treated?
This remains a contentious subject, and differs worldwide. The majority of AOM is self-limiting and will resolve within 3 days without treatment. Severity of symptoms, duration, presence of systemic symptoms, and the age of the child will influence the management.
Antibiotic treatment for acute otitis media is the single most common prescription in many Western countries. The use of antibiotics is controversial and generally discouraged for earache and opposed to “clinically certain” acute otitis media.
Although a lack of high-level evidence exists, there is a general consensus as the management of earache or symptoms of “early” AOM. If the patient is systematically well, it is reasonable to watch and wait for 24-48 hours with review after this. Paracetamol and ibuprofen provide effective analgesia and control of temperature symptom. A provisional review appointment should be offered for 48 hours to re-asses the signs and symptoms.
ENT Doctor London is one of UK’s leading Nose Surgeon London clinics, and can be contacted on 0207 580 6970.