An acute inflammation of the middle ear, usually suppurative, occurring after an upper respiratory tract infection, rhinitis and sinusitis. The commonest organisms are Streptococcus, H. influenzae.

Clinical Features

Pain in the ear. Loss or impairment in hearing with or without ear discharge. Loss of appetite, fever. Examination shows signs of URTI, fever, hyperaemic oedematous tympanic membrane with loss of normal contours. Purulent discharge with perforation (central) may be present.

Management

• Majority can be treated as outpatients

• Adequate rest

• Analgesics:

- aspirin 10 mg/kg TDS for 5 days (avoid in children because of risk of Reye's syndrome)

OR

- paracetamol 10 mg/kg TDS for 5 days

• Antibiotics:

- amoxycillin 15 mg/kg TDS for 10 days OR

- cotrimoxazole 24 mg/kg BD for 10 days OR

- erythromycin 30-50 mg/kg QDS for 10 days.

• Aural toilet and topical antibiotics can be given if spontaneous healing does not occur in a discharging ear.

Admit If

• Symptoms and signs of septicaemia appear

• Features of meningitis appear

• Convulsions occur (in children).