Otitis Media

 

Acute Otitis Media (AOM)

Definition/diagnostic criteria

Acute Otitis Media (AOM) is characterized by the rapid onset of signs and symptoms of inflammation in the middle ear, typically including earache, fever, and hearing loss. The diagnosis is primarily clinical, focusing on otoscopy findings such as a bulging tympanic membrane, middle ear effusion, and erythema.

Epidemiology

AOM is a common condition, particularly in children aged 6 months to 2 years. It is one of the leading causes of doctor visits and antibiotic prescriptions for children in the UK.

Diagnosis

Clinical features

Key symptoms include otalgia, fever, irritability, otorrhea (in case of tympanic membrane perforation), and hearing loss.

Investigations

Diagnosis is mainly clinical. A swab may sometimes be required in the context of discharge.

Treatment

Management involves pain relief with analgesics such as paracetamol or ibuprofen. Antibiotic therapy, primarily with amoxicillin, is recommended for certain cases, such as children under 2 with bilateral AOM or with otorrhea, or in severe cases.

Prognosis

Most children recover fully without complications. Persistent effusion can occur but usually resolves within 3 months. Rare complications include mastoiditis.

 

Chronic Otitis Media (COM) and Cholesteatoma

Definition/diagnostic criteria

Chronic Otitis Media (COM) is characterized by persistent inflammation of the middle ear and mastoid cavity, which may include tympanic membrane perforation and recurrent otorrhea. Cholesteatoma, a complication of COM, involves the presence of keratinizing squamous epithelium in the middle ear, leading to bone erosion.

Epidemiology

COM and cholesteatoma are less common than AOM but represent significant chronic health issues, requiring ongoing management and potentially surgery.

Diagnosis

Clinical features

Persistent or recurrent ear discharge, hearing loss, and tympanic membrane perforation are typical of COM. In cholesteatoma, there may be a history of persistent otorrhea, hearing loss, and often a visible mass behind the tympanic membrane.

Investigations

Otoscopy for COM and cholesteatoma, with particular attention to the status of the tympanic membrane and the presence of cholesteatoma. Audiometry assesses the degree of hearing loss. CT scanning is crucial for evaluating the extent of cholesteatoma and planning surgery.

Treatment

COM treatment focuses on controlling infection and maintaining a dry ear; topical antibiotics and ear cleaning are mainstays. Surgery may be required to repair the tympanic membrane or remove cholesteatoma and improve hearing.

Prognosis

The outcome for COM is generally good with appropriate management, though some may have persistent hearing loss. Cholesteatoma requires surgical intervention due to the risk of serious complications, including mastoiditis and intracranial spread.

Further reading

Published: 31st July 2022 Updated: 12th April 2024

Report errors, or incorrect content by clicking here.

What is Pulse Reference?

Based on the best-selling book Symptom Sorter. Pulse Reference is designed to help GPs make sense of patient presentations. It analyses a multitude of symptoms commonly seen in primary care and for each presents differentials, distinguishing features, possible investigations and key points. It also provides guides on managing more than 350 conditions. The perspective is very much grass roots primary care, informed by the latest evidence and guidance.

Learn More

Disclaimer

Pulse Reference is based on the best-selling book Symptom Sorter. The experts behind Pulse Reference are Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse’s editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse. This website is for clinical guidance only and cannot give definitive diagnostic information. Practitioners should work within the limits of their individual professional practice, seek guidance when necessary and refer appropriately.