Definitions
Acute otitis media: |
Acute purulent exudate in the middle ear without discharge (acute suppurative otitis media) |
Secretory otitis media |
Multifactorial non-purulent inflammatory condition in the middle ear with serous or mucous discharge. Also a residual condition after acute otitis. |
“Ear - Child” |
A child suffering from acute otitis three or more times within a six month period. |
Therapy failure |
Insufficient or absent therapeutic effect or worsening of acute otitis during therapy with antibiotics. |
Acute otitis media usually follows a viral infection, the bacterial infection is caused by:-
• Pneumococci
• Haemophilus influenzae
• Groups A streptococci
• Moraxella catarrhalis
Clinical systems
Acute otitis media
• previous common cold
• pain
• restlessness
• usually feverish
• hearing often reduced
• possible discharge of pus from ear
Simplex otitis
May present one or more of the above symptoms in a less pronounced form but without any discharge from the ear
Secretory otitis
• little or no pain
• gradual loss of hearing
• “popping” in the ear (rarely)
• often discovered by chance.
Treatment guidelines
Acute otitis media should be treated with antibiotics or paracentesis. Culture of a discharge (if any) could be of a great help to identify the causative bacteria.
Drug of choice |
Phenoxymethylpenicillin |
Adult |
250 - 500 mg every 6 hours for 5 days |
Children up to 5 years: |
6 mg/kg every 6 hours for 7 days |
6-12 years: |
250 mg every 6 hours for 7 days |
NOTE Treatment periods shorter than five days increase the risk of treatment failure |
Second choice |
Erythromycin |
Adult and Children |
|
above 8 years |
250 - 500 mg every 6-8 hours for 5 days |
Children up to 8 years: |
10 mg/kg every 6-8 hours for 5 days |
Symptomatic treatment of acute otitis media and simplex otitis
• Analgesics (e.g. Paracetamol 10 mg/kg body weight every 6-8 hours, or Acetylsalicylic acid). Avoid Acetysalicylic acid if it is viral infection
• Elevation of the upper part of the body
• Decongestive nasal drops or nasal spray e.g. Ephedrine hydrochloride
• Oral decongestants and antihistamines are not indicated.
Treatment of simplex otitis
If the patient is severely affected by fever and pain or the symptoms continue without improvement, antibiotics should be given. The treatment schedule for acute otitis media should be as followed.
Referral to Specialist:
• Children with high fever who are toxically affected or children with severe pain that persists in spite of treatment
• Treatment failure without improvement after change of antibiotics
• “Ear Children”
• Otitis in the normal (or better hearing) ear combined with permanent hearing loss in the other ear.
Secretory otitis media
Treatment guidelines
• Initial inspection
• Nasal drops, oral decongestants and antihistamines have no demonstrable effect on this condition
• Secretory otitis with hearing loss that does not improve should be referred to a specialist.
