The ear is made up of the external, middle and inner ear. Otitis media is an infection of the
middle ear that is usually preceded by upper respiratory tract infection. The infection can be of
viral or bacterial origin. Acute otitis media (AOM) commonly affects children less than 3 years
old, and less frequently affects adults. AOM symptoms include: high fever, ear pain, ear tugging,
ear discharge for less than 2 weeks, hearing loss when fluid accumulates in the middle ear,
irritability, headache, vertigo and tinnitus. In severe or untreated infections, the ear drum
ruptures releasing pus from the middle ear. Recurrent ear infections result in hearing loss
affecting speech development in children. Guidelines recommend that AOM is first treated with
analgesics like ibuprofen or paracetamol. Antibiotics like amoxicillin or amoxicillin-clavulinic
acid are added if infection is bacterial. Azithromycin or clarithromycin are alternatives in
penicillin allergy. In cases of recurrence of more than 3 episodes in 6 months, ventilation tubes
(grommet tubes) may be placed in the ear to help in aeration and drainage of accumulated middle
ear fluid. Chronic suppurative otitis media (CSOM) follows untreated AOM and presents with
purulent ear discharge lasting more than 2 weeks, hearing loss and a dull ear ache. Investigations
done include an audiogram to assess hearing, CT scan to assess the mastoid and middle and inner
ear structures and MRI if intracranial or intratemporal complications are suspected. Treatment
for CSOM includes aural toilet, topical ear antibiotics and steroids, keeping the ear dry. Systemic
antibiotics are given if topical treatment fails or in cases of mastoiditis. Surgery may involve
tympanoplasty or mastoidectomy. Otitis media can be prevented by avoidance of ear bud use,
reducing exposure to smoke and overcrowded places, exclusive breastfeeding and giving
pneumococcal and influenza vaccine.
By Dr. Warugongo L.N

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