Generally there are 3 categories of ear infections in children.
- (Recurrent) Acute otitis media – (R)AOM common
- Otitis externa – OE common
- Chronic suppurative otitis media – CSOM uncommon
(R)AOM – If 4 or more episodes in 6 months or 6 or more episodes in a year refer ENT
OE – If no improvement despite appropriate management refer to ENT
CSOM – If no improvement despite appropriate management and suspicion of CSOM refer to ENT
General Practice management
- (R)AOM (Recurrent Acute Otitis Media
Usually develops after/with a URTI on the background of OME.
Symptoms: Pain, discharge, fever, malaise
Examination: dull, deep seated ache, drum red, bulging
Management:
Usually supportive measures only
If under 2 years old and/or severely systemically unwell, consider oral antibiotics (amoxicillin)
Refer urgently if complications (mastoiditis)
2. Otitis Externa
Usually develops after swimming/water exposure (but not always)
Symptoms: Pain, tender to touch – particularly pressure on tragus or pulling backwards of pinna to examine canal; discharge, usually systemically well
Examination: Pain as above, discharge in canal, often oedematous canal, looks wet
Management
Take swab if not settling after initial management (might be fungal)
Topical antibiotic drops: Locorten Vioform, Gentisone HC
If perforation suspected: Cilodex, Ciprofloxacin
If fungal infection: long term (at least 6 weeks-2 weeks after symptoms have disappeared) course of Canestan
Oral antibiotics do not work and are only indicated if the infection has spread to cause facial cellulitis.
3. CSOM Chronic suppurative otitis media
Either due to chronic perforation or cholesteatoma
Symptoms: Recurrent infection, often very smelly, often painless without other symptoms. Initial response to topical/oral treatment short lived-frequent relapses
Examination: Copious smelly discharge, often little else to see
Management:
Topical and oral antibiotics-if no resolution or recurrence:
Refer to ENT OPD
