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Urgent
ACUTE OTITIS MEDIA: A COMMON ENT DISEASE AND THINGS TO NOTE IN TREATMENT
Acute otitis media (AOM) is an inflammation or infection of the middle ear cavity, located behind the eardrum, accompanied by the accumulation of fluid or pus. This condition can develop after upper respiratory tract infections. In children, AOM is very common due to immature Eustachian tubes and a developing immune system. It can also occur in adults, but less frequently and is often associated with co-existing medical conditions.
Acute otitis media typically present acutely and may be resolved spontaneously in many cases with good supportive management; however, there is also a risk of complications if diagnosis or treatment is delayed.
Classification
Based on clinical characteristics, duration, and severity, acute otitis media can be classified as follows:
By age: young children (such as under 2 years old) and adults. Young children often have higher risk and more severe symptoms.
By severity/symptoms:
Severe AOM with intense pain, high fever, significant discomfort, or impact on daily activities.
Mild-to-moderate AOM with less pain, which can be monitored if there are no risk factors.
Based on structural changes: with or without tympanic membrane perforation with discharge (otorrhea).
Based on prolonged/recurrent disease: if acute otitis media occurs in multiple episodes or does not respond to treatment or has complications.
Causes
The main causes of acute otitis media are identified as follows:
Microorganisms: Bacteria and viruses are common causative agents.
Respiratory viruses: can cause initial infections, leading to inflammation of the nasopharyngeal mucosa and impaired Eustachian tube function, thereby creating conditions for bacterial growth.
Predisposition: Young children due to their immature Eustachian tube structure. Individuals with rhinitis, allergies, or conditions that obstruct the Eustachian tube.
Environmental/Exogenous factors: Exposure to upper respiratory viral infections, polluted environments, smoking, climate change, and humidity.
Symptoms
The clinical symptoms of acute otitis media vary depending on age and the extent of damage, including:
Ear pain (otalgia), usually acute pain, which may worsen when lying down.
Fever, especially in children, which can be mild or high.
Temporary hearing loss due to fluid in the middle ear reducing sound transmission.
Feeling fullness or pressure in the middle ear.
Ear discharge (otorrhea) if the eardrum is perforated.
In young children: irritability, difficulty sleeping, poor feeding, and may vomit or experience sleeplessness due to pain.
Diagnosis
Diagnosis of acute otitis media is based on a combination of medical history, clinical examination, and when necessary, supportive tests:
1. Medical history:
Rapid onset of symptoms such as ear pain, fever, and discomfort.
History of upper respiratory tract infection (URTI).
2. Clinical examination:
Otoscopy to examine the tympanic membrane: looking for a bulging, red tympanic membrane, loss of light reflex, and reduced mobility if a pneumatic otoscope is used.
Identification of middle ear effusion.
3. Supportive tests:
Tympanometry to measure middle ear pressure and assess tympanic membrane mobility.
Audiometry if prolonged hearing loss is suspected or after recurrent AOM or complications.
Treatment
Treatment for acute otitis media focuses on pain control, considering antibiotic use, and specialist medical intervention if necessary.
1. Pain relief
Use painkillers/fever reducers such as paracetamol or ibuprofen to control pain and fever.
Ear drops can be used if the eardrum is intact and prescribed by a doctor.
2. Observation and antibiotic use
In cases of mild symptoms, without risk factors, doctors may observe for 48-72 hours to see if it is resolved naturally if not severe.
If symptoms are severe, with significant pain, high fever, in young children below a certain age, or if there is ear discharge, then antibiotics should be started early.
3. Antibiotic selection
Amoxicillin is often the first-line choice if there are no contraindications.
If there is a contraindication to penicillin or if initial treatment fails, the doctor may choose a combination of amoxicillin-clavulanate, or other appropriate antibiotics based on local bacteria.
4. Monitoring and adjusting treatment
If after 48-72 hours of treatment or observation, there is no improvement or signs of worsening, a follow-up examination is necessary to consider changing antibiotics or further intervention.
Evaluate hearing if middle ear fluid persists long-term or after multiple episodes of AOM.
5. Surgery / specialty: in cases of complications such as large eardrum perforation, prolonged pus discharge, ear or eardrum surgery (myringotomy), tympanostomy tubes may be necessary to drain fluid and reduce middle ear pressure.
Reference:
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