Otitis Media

Acute Otitis Media is an infection of the middle ear compartment. It is more common in children because the Eustachian tube that connects the postnasal space and middle ear is immature in children, large adenoids are found in young children, they suffer more episodes of sinusitis and upper respiratory tract infection (URTI).

Symptoms include

  1. Ear pain – can be intense, affecting sleep. Young children can cry incessantly and be inconsolable.
  2. Fever
  3. Hearing loss
  4. Discharge – this usually indicates rupture of the eardrum. Usually accompanied by relief of ear pain

Treatment includes oral antibiotics, analgesia (pain relief). If there is discharge, ear toilet with suction followed up ear drops is usually required. If medical treatment does not resolve the infection, surgical drainage through a cut in the eardrum (myringotomy) can be done.

Otitis Media with Effusion (OME) is the presence of non-infected fluid in the middle ear compartment. It can develop spontaneously or from an acute otitis media. Predisposing factors includes

  1. Large adenoids
  2. Acute Otitis Media
  3. Allergic Rhinitis
  4. Sinusitis

Unlike the acute otitis media, there is no ear pain. The main symptom is hearing loss. When it is bilateral, it can lead to speech and language impairment and learning disabilities.

Treatment – the decision on the best course is dependent on the age of child, the level of speech and language development and number of previous episodes of OME.

  1. The first-line treatment is conservative. A course of oral antibiotics will resolve the fluid in a majority of patients.

Surgical drainage – if medical treatment cannot resolve the fluid, surgical drainage (myringotomy) and grommet tube insertion is performed. If the adenoids are large, they are usually removed at the same time. If there is sinusitis, a sinus washout is also included.