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15.2 Otitis Media (Acute or Chronic)

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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

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