Acute otitis media is extremely common in young children, with around half of children having three or more episodes by the age of 3 years.

Pathophysiology

• whilst viral upper respiratory tract infections (URTIs) typically precede otitis media, most infections are secondary to bacteria, particularly:
  • Streptococcus pneumonaie (most common cause)
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Haemophilus Influenzae
• viral URTIs are thought to disturb the normal nasopharyngeal microbiome, allowing bacteria to infect the middle ear via the Eustachian tube

PC

• Otalgia

• some children may tug or rub their ear

• fever occurs in around 50% of cases
• hearing loss
• recent viral URTI symptoms are common (e.g. coryza)
• ear discharge may occur if the tympanic membrane perforates

Examinations

Autoscope:

• bulging tympanic membrane → loss of light reflex
• opacification or erythema of the tympanic membrane
• perforation with purulent otorrhoea
• decreased mobility if using a pneumatic otoscope