Acute otitis media

Acute (suppurative) otitis media
- Epidemiology
  - Infants
  - Small children
  - 80% by 3 years of age
- Etiology
  - Bacterial superinfection (on viral URTI) which ascends through eustachian tube
  - S. pneumoniae
  - H. influenzae
- Risk factors
  - Previous AOM
  - Chronic otitis media
  - Parental smoking
- Protective factors
  - Prolonged breastfeeding
  - Pneumococcal vaccine
- Clinical features
  - Ear pain
    - Infants repeatedly touch the ear
  - Fever
  - Discharge from ear
    - Only if there is spontaneous tympanic perforation
  - Conductive hearing loss
- Diagnosis
  - Early: Retracted, hypomobile tympanic membrane
  - Then: Bulging tympanic membrane
    - Due to accumulation of pus
  - Loss of light reflex
- Treatment
  - NSAIDs
  - Not decongestants! – prolong course
  - Antibiotics
    - Only in < 2 years, or > 2 years if bilateral, no resolution in 2 days
    - Amoxicillin
    - Clavulanic acid added if treatment failure
- Complications
  - Intratemporal complications
    - Mastoiditis
      - Children
      - Infection spread to mastoid -> collection of pus -> destruction of air cells -> empyema
      - Antibiotics
        Always!
        
        Vancomycin
      - Mastoidectomy in severe cases
    - Peripheral facial nerve palsy
    - Labyrinthitis
      - Inflammation of inner ear
      - Vertigo
      - Nystagmus
      - Sensorineural hearing loss
  - Intracranial complications
    - Meningitis
    - Otogenic abscess
      - Epidural, subdural or cerebral
      - Headache
    - Sinus thrombosis
  - Extracranial complications
    - Bezold abscess
      - Deep to sternocleidomastoid, pus from mastoiditis erodes through the mastoid part of the temporal bone

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