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Otitis media

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VOL: 101, ISSUE: 07, PAGE NO: 30

What is it?

What is it?
- Otitis is a term for inflammation of the ear. Otitis media is inflammation of the middle ear.

- Acute otitis media is a short-term inflammation.

- Recurrent acute otitis media involves more than four episodes in six months (NICE, 2000).

- Diagnosis should not be made on a history alone. The eardrum should be examined for any bulging of the tympanic membrane, changes in colour or perforation with discharge.

Causes
- The main bacteria responsible are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella cattarhalis.

- Viruses are implicated in about 25 per cent of cases.

Risk factors
- Age is the most important risk factor. It is predominantly a disease of infancy and early childhood.

- Children in day care or with older siblings have an increased risk.

- There is a greater incidence in children with parents who smoke.

Incidence
- At least 25 per cent of children have a minimum of one episode before they are 10 years old.

- The peak incidence occurs in children aged between three and six (Scottish Intercollegiate Guidelines Network, 2003).

Signs and Symptoms
- Pain is the main symptom. In very young children this may present as irritability, crying or ear tugging.

- Loss of hearing may occur due to effusion in the middle ear.

- In more severe cases, common symptoms are fever, loss of appetite, nausea and vomiting, and loss of sleep.

- Tinnitus, voice resonance and dizziness may also occur.

Differential diagnosis
- Otitis media with effusion has similar signs or symptoms.

- Otitis externa may cause earache. It is more common in adults and is frequently bilateral.

- Otitic barotrauma is more likely in people who have recently travelled by aeroplane, scuba dived, or received a blow to the ear.

- Mastoiditis may have developed from a previous episode.

- A foreign body may be the cause of ear pain, particularly in children.

- Impacted earwax may be a cause of ear pain in adults.

- Referred otalgia, from teeth, jaw or cervical spine, should be considered in people who only have earache and none of the other typical symptoms.

Treatment
- In children, about 80 per cent of episodes of acute otitis media will resolve within three days without treatment (Glasziou et al, 2003).

- There is no consensus on the best treatment and the issue of the use of antibiotics remains contentious.

- The benefits of antibiotics should be weighed against their adverse effects and the likelihood of the infection being viral.

- Analgesia, paracetamol or ibuprofen are the main treatments.

Complications
- Children with recurrent acute otitis media must be referred (NICE, 2000).

- Mastoiditis or facial nerve paresis requires urgent referral (SIGN, 2003).

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