In young children aged under 2, who are not yet immunocompetent, recurrent ear infections (recurrent acute otitis media) are common and up to 6 episodes per year can be considered normal.
This can in part due to the presence of Otitis Media Effusion (OME) – Glue Ear.
Other factors include recurrent URTI and teething.
History:
- Usually develops with / after an URTI on the background of OME.
- Symptoms: pain, discharge, fever, malaise
- Pain is a dull, deep-seated ache.
Examination:
- Otoscopy – drum red, bulging
- Can include discharging ear if tympanic membrane perforation (‘abscess draining’).
Please also see Primary Care Management.
Who to refer:
Refer urgently if complications (mastoiditis)
Who not to refer:
In young children (R)AOM is very common and less than 6 episodes in a year (or 4-5 in 6 months) do not constitute significant recurrence or need for intervention, unless the child is exceptionally unwell and adequate medical measures have failed.
Primary Care Management
- Supportive care (analgesia, antipyretics)
- If child <2 and especially unwell consider antibiotics (usually amoxicillin)
- If ongoing ear discharge, topical ear drops – Ciprofloxacin with Betamethasone
- Prolonged course of antibiotics (usually amoxicillin, 1/3 of daily dose for 3 months) if recurrent and troublesome but less than 6 episodes/year. This can provide protection from infection until natural immunity has improved.
Refer urgently if complications (mastoiditis).
