Pathophysiology

Streptococcus pneumonaie (most common cause). Also commonly causes other ENT infections such as rhino-sinusitis and tonsillitis

Other causes:

• Haemophilus influenzae
• Moraxella catarrhalis
• viral URTIs are thought to disturb the normal nasopharyngeal microbiome, allowing bacteria to infect the middle ear via the Eustachian tube

chronic OM is caused by gram- and pseudomonas

PC

Otalgia is the primary presenting feature of otitis media in adults

May also present with:

• fever
• hearing loss
• recent viral URTI symptoms are common (e.g. coryza, cough, sore thorat)

Examinations

Otoscope:

A normal tympanic membrane is “pearly-grey”, translucent and slightly shiny. You should be able to visualise the malleolus through the membrane. Look for a cone of light reflecting the light of the otoscope.

Otitis media will give a bulging, red, inflamed looking membrane. When there is a perforation, you may see discharge in the ear canal and a hole in the tympanic membrane.

OM with effusion - fluid from the middle ear will not be clear, will be (mucopurulent discharge)