Ear infections in children

Recurrent Acute Otitis Media (R)AOM

• In young children this is very common and less than 5 episodes in a year (or 4 in 6 months) do not constitute recurrence or need for intervention, unless the child is exceptionally unwell and adequate medical measures have failed.

Otitis Externa (OE)

• If no improvement despite appropriate management, refer to ENT

Chronic Suppurative Otitis Media (CSOM)

• If no improvement despite appropriate management refer to ENT

(R)AOM (see separate RefHelp page)

History:

• Usually develops after/with an URTI, often on the background of OME.
• Symptoms: Pain (deep-seated ache), discharge, fever, malaise
• Examination: drum dull, red, bulging.

Otoscopy:

• Can include discharging ear if tympanic membrane perforation (“abscess draining”).

Management:

• Supportive care (analgesia, antipyretics)
  • If child <2 and especially unwell consider antibiotics (usually amoxicillin).
• If ongoing ear discharge, topical ear drops – Ciprofloxacin / Betamethasone
• Prolonged course of antibiotics (usually amoxicillin, 1/3 of daily dose for 3 months) if recurrent and troublesome but less than 5 episodes/year. This can provide protection from infection until natural immunity has improved.

Refer urgently if complications (mastoiditis).

Otitis Externa (see separate RefHelp page)

History:

• 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: Sharp pain as above, discharge in canal, often oedematous.

Otoscopy:

• Wet, discharge in canal, can be smelly and bloody.

Management

• Take swab (might be fungal)
• Topical antibiotic drops: Flumetasone / clioquinol (not for age under 2),Gentamicin / Hydrocortisone
• If perforation suspected: Ciprofloxacin, Ciprofloxacin / Betamethasone
• If fungal infection: long term course of clotrimazole (at least 6 weeks – and 2 weeks after symptoms have disappeared)
• Oral antibiotics do generally not work and are only indicated if the infection has spread to cause facial cellulitis.

CSOM (see separate RefHelp page)

• Either due to chronic perforation or cholesteatoma
• Very rare, usually unilateral
• Complications:
  • If cholesteatoma, can lead to mastoiditis, meningitis, cerebral complications.

History:

• 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
  • Refer urgently if complications.