QuestionSBA
QuestionChoice
There is no evidence to support the use of antihistamines in acute otitis media
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d
Regular analgesia and an antihistamine
QuestionChoice
Antibiotics are advised for those who are suspected to have acute otitis media and a systemic infection. Also, those with otorrhoea or those aged less than 2 with a bilateral infection may benefit from a short course of antibiotics, usually amoxicillin. Acute otitis media will normally improve within 3 days without the need for antibiotic treatment so they should not be used in this case
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e
Regular analgesia and a short course of antibiotics
QuestionChoice
The patient has acute otitis media. Regular paracetamol or ibuprofen is the advised treatment for those who present with no acute complications or systemic illness
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a
Regular analgesia
QuestionChoice
There is no evidence to support the use of decongestants or antihistamines in acute otitis media
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c
Regular analgesia, a decongestant and an antihistamine
QuestionChoice
There is no evidence to support the use of decongestants in acute otitis media
32834
b
Regular analgesia and a decongestant
QuestionComment
@Quesmed some general obs results would be nice as we don't want to just assume patients are otherwise systemically well
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Acanthosis Nigracan't
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16-year old girl*
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weird hangup to have

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Acute Hematoma
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Intravenous DNA
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# Summary

Otitis media is inflammation of the middle ear often resulting from an infection. Key signs and symptoms include rapid-onset pain, fever, irritability, anorexia, vomiting, and impaired hearing. Diagnosis is based on history and physical examination, notably the appearance of the tympanic membrane. Management mainly consists of treating pain and fever. Antibiotics are reserved for children who are systemically unwell or at high risk of complications. Complications, although rare, can be life-threatening and include both intracranial and extracranial complications.

# Definition

Otitis media is an infection-induced inflammation of the middle ear, frequently occurring after a viral upper respiratory tract infection.

# Epidemiology

Otitis media is a common condition, predominantly affecting young children. 

# Aetiology

The primary cause of otitis media is bacterial infection, particularly common in young children, often following a viral upper respiratory tract infection. 

# Signs and Symptoms

Acute otitis media is characterised by:

- Rapid onset of deep-seated ear pain
- Fever
- Irritability
- Anorexia
- Vomiting
- Impaired hearing
- Systemic illness
- Aural fullness followed by discharge when the tympanic membrane perforates, leading to relief of pain
- Injection of blood vessels and diffuse erythema of the tympanic membrane

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Chronic otitis media can present as:

- Benign chronic otitis media: a dry tympanic membrane perforation without chronic infection
- Chronic secretory otitis media or "glue ear": persistent pain lasting weeks after the initial episode with an abnormal-looking drum and reduced membrane mobility
- Chronic suppurative otitis media: persistent purulent drainage through the perforated tympanic membrane

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# Differential Diagnosis

The main differentials for otitis media include:

- Otitis externa: characterised by pain exacerbated by tugging of the auricle, accompanied by otorrhoea and possible hearing loss
- Mastoiditis: presenting with postauricular pain, erythema, and swelling, as well as protrusion of the ear
- Temporomandibular joint disorder: characterized by jaw pain, difficulty in opening the mouth, and clicking or popping sounds during jaw movement

# Investigations

Diagnosis of otitis media is primarily clinical, based on history and physical examination, notably the appearance of the tympanic membrane.

If however there are concerns of **mastoiditis**, such as if there is continued systemic upset despite antibiotic treatment, a CT head should be arranged in the first instance. Mastoiditis is primarily managed with IV antibiotics although surgical intervention is sometimes needed.

# Management

In managing otitis media:
 
- Admit any children under 3 months with a temperature of 38 degrees Celsius or more, or children with suspected acute complications of otitis media such as meningitis, mastoiditis, or facial nerve palsy.
- Consider admitting any children who are very systemically unwell.
- Otherwise, treat pain and fever with paracetamol or ibuprofen.
- Most children will not require antibiotics. A delayed antibiotic prescribing strategy can also be appropriate. This involves asking patients/parents to start taking antibiotics if symptoms don't improve within four days.
- Offer an immediate antibiotic prescription to children who are systemically unwell (but don't require admission) or those at high risk of complications (e.g., immunocompromised patients).

# Complications

Complications of otitis media can be divided into intracranial and extra-cranial complications. They are potentially life-threatening and require immediate assessment and treatment.

Extra-cranial complications include:

- Facial nerve palsy
- Mastoiditis
- Petrositis
- Labrynthtitis

Intra-cranial complications include:

- Meningitis
- Sigmoid sinus thrombosis
- Brain abscess

# References

[Click here for NICE CKS on otitis media - acute](https://cks.nice.org.uk/topics/otitis-media-acute/)
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An example appearance of otitis media.
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Acute otitis media in children without complications or systemic illness is usually managed with regular analgesia, such as paracetamol or ibuprofen, to relieve pain.
A 16-year-old woman attends her GP due to otalgia in her right ear. She has had the pain for the last 2 days. On otoscopic examination the GP identifies a cloudy and slightly bulging tympanic membrane.

What is the correct management?
a