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Acute otitis media, acute inflammation of the middle-ear cavity, is a common condition and is frequently bilateral. It occurs most commonly in children and it is important that it is managed with care to prevent subsequent complications.
It most commonly follows an acute upper respiratory tract infection and may be viral or bacterial. Unless the ear discharges pus from which an organism is cultured it is impossible to decide one way or the other.
Acute otitis media is an infection of the mucous membrane of the whole of the middle-ear cleft—Eustachian tube, tympanic cavity, attic, aditus, mastoid antrum and air cells. The bacteria responsible for acute otitis media are: Streptococcus pneumoniae 35%, Haemophilus influenzae 25%, Moraxella catarrhalis 15%. Group A streptococci and Staphylococcus aureus may also be responsible.
The sequence of events in acute otitis media is as follows:
Causes of Acute Otitis Media are,
Earache may be slight in a mild case, but more usually it is throbbing and severe. The child may cry and scream inconsolably until the ear perforates, the pain is relieved and peace is restored.
Deafness is always present in acute otitis media. It is conductive in nature and may be accompanied by tinnitus. In an adult, the deafness or tinnitus may be the first complaint.
The child is flushed and ill. The temperature may be as high as 40°C.
There is usually some tenderness to pressure on the mastoid antrum.
Changes in tympanic membrane
The tympanic membrane varies in appearancenaccording to the stage of the infection.
Mucoid discharge from an ear must mean that there is a perforation of the tympanic membrane. There are no mucous glands in the external canal.
The treatment depends on the stage reached by the infection.The following stages may be considered: early, bulging and discharging.
Myringotomy is necessary when bulging of the tympanic membrane persists, despite adequate antibiotic therapy. It should be carried out under general anaesthesia in theatre and a large incision in the membrane should be made to allow the ear to drain. Pus should be sent for bacteriological assessment.
Following myringotomy, the ear will discharge and the outer meatus
should be dry-mopped regularly.
If the ear is already discharging when the patient is first seen, a swab should be sent for culture of the organism. Antibiotic therapy should be started but modified if necessary when the result