It is an inflammation of the middle ear cavity. It is considered acute when the inflammation is of less than 2 weeks duration, and chronic when the inflammation is of more than 2 weeks duration with tympanic membrane perforation.
Diagnostic Criteria
- Examine the pinna;
- Using an otoscope carefully examine the external auditory canal and the tympanic membrane
15.2.1 Acute Otitis Media
Diagnostic Criteria
- Previous upper respiratory tract infection
- Painful ear
- Restlessness
- Fever
- Hearing often reduced
- Inflamed, bulged tympanic membrane
Non-Pharmacological Treatment:
Acute otitis media should be treated with analgesics, antibiotics and/or paracentesis (to reduce pain and to obtain pus for culture and sensitivity)
Pharmacological treatment: 4, 5
A: Phenoxymethylpenicillin (PO). Adults: 500mg 6 hourly for 10days; Children up to 5 years: 6 mg/kg 6 hourly for 10 days
OR
B: Amoxicillin+Clavulanic acid 375–625mg 12 hourly for 10 days
OR (for patients who are allergic to penicillin)
A: Azithromycin (PO). Adults: 500mg once daily for 5 days and Children 10mg/kg once daily for 5 days
AND
A: Paracetamol (PO). Adults: 1g 6 hourly for 3 days and Children: 10 mg/kg 6 hourly for 3 days
Note: Treatment periods shorter than 10 days increase the risk of treatment failure
Referral:
- Children with high fever, severe ear pain, headache, altered state of consciousness
- A chronically discharging ear that persists in spite of proper treatment.
- Foul smelling ear discharge
- Mastoiditis
- Otitis in the normal (or better hearing) ear combined with permanent hearing loss in the other ear
15.2.2 Chronic Suppurative Otitis Media
Diagnostic Criteria
- Discharge of pus from the ear
- Perforated tympanic membrane
Non-Pharmacological Treatment:
- Keep ear dry/avoid water into the ear
- Aural toilet – ear suctioning under direct vision, removal of debris
- Ear wicking regularly, with a dry cotton wick at home
Pharmacological Treatment
C: Ciprofloxacin ear drops, three drops12 hourly for 14 days
AND
A: Ciprofloxacin (PO). Adults: 500mg 12 hourly for 10 days and Children: 10–20mg/kg 12 hourly for 10 days
OR
C: Cefaclor (PO). Adults: 250mg 8 hourly for 10 days and Children 1–5 years: 125mg 8 hourly for 10 days
Note: Treatment of shorter than 10 days will result into treatment failure
15.2.3 Mastoditis with Sub-periosteal Abscess
It is due to infection of the mastoid air cells in the middle ear, a complication of chronic suppurative otitis media. It presents as a fluctuant painful swelling on the post auricular area. The overlying skin is also inflamed.
Non-Pharmacological Treatment
Aspirate the swelling before incision and drainage, and then referfor mastoidectomy at a zonal/national hospital
Pharmacological Treatment:
C: Ciprofloxacin ear drops, three drops, 12 hourly for 14 days
AND
A: Ciprofloxacin 500mg 12 hourly for 10 days; Children 10–20mg/kg 12 hourly for 10 days
OR
D: Cefaclor 250mg 8 hourly for 10 days. Children (1–5 years) 125mg 8 hourly for 10 days
Note: Treatment shorter than 10 days will result into treatment failure
15.2.4 Otitis Media with Effusion
It is a multifactorial, inflammatory condition in the middle ear with serous or mucous accumulation without ear discharge. It is a residual condition after acute otitis media.
Diagnostic Criteria
It is often discovered by chance.
- Little or no ear pain
- Gradual loss of hearing
- No ear discharge
Non-Pharmacological Treatment
- Close follow-up
Note: Otitis media with effusion with hearing loss that does not improve after 3 months should be referred to a specialist for myringotomy and grommets insertion