Otitis Media, Acute (AOM)

Notes
  • This is an inflammation of middle ear that occurs after respiratory tract infection, rhinitis or sinusitis.
  • It is normally suppurated (i.e. produce or discharge pus)
  • The disease is mainly caused by infections by Streptococcus pneumonia and Haemophilus influenza
  • In some few cases, AOM can be caused by viral pathogens such as respiratory syncytial virus (RSV) and rhinovirus
  • It mostly affects children below 5 years
  • Most cases of AOM will resolve spontaneously with no sequelae
  • Some may progress to chronic suppurative otitis media.
  • Statistics: AOM affects 11% of the global population annually, 50% being children below 5 years; in the USA, AOM is the most common condition in children under 5 years who are treated in health facilities; Otitis media (acute or chronic) caused 2,400 deaths in 2013 globally

##Risk factors for AOM

  • Supine position of feeding
  • Formula feeding
  • Early first episode of AOM
  • Young age
  • Male
  • Smoking and passive smoking
Symptoms
  • Pain in the ear
  • Ear discharge, occasionally
  • Impairment of hearing
  • Fever
  • Malaise
  • Coryza/rhinorrhea
  • Vomiting
  • Irritated, restless baby who may be pulling the ears
  • It may lead to meningitis and/or mastoiditis
  • Red, yellow or cloudy and/or bulging of the tympanic membrane
Diagnosis
  • Clinical evaluation
Differential
  • Respiratory Tract infections
  • Cholesteatoma (an abnormal skin growth in the middle ear behind the eardrum)
  • Mastoiditis
  • Myringitis
  • Otitis externa
  • Chronic suppurative otitis media
  • Foreign body in the ear channel
  • Referred pain
  • Herpetic infection of the ear
Prevention
  • Routine immunization of children
  • Avoiding exposure to passive smoking
Management
  • Analgesics such as Syr/Tabs Paracetamol  10mg /Kg TID x 5/7
  • Antibiotics such as: Syr / Caps Amoxicillin  25 – 50mg /kg TID x 5/7 or  Susp/Tabs Erythromycin 30 – 50mg /kg TID x 5/7
  • If the patient has not improved after 5 days, repeat the above treatment.
  • In cases where perforation occurs, treat as Chronic Suppurative Otitis Media
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