Ear infections in children

(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

1. (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  

Or just something never encountered before:            

Management:

          Topical and oral antibiotics-if no resolution or recurrence:

          Refer to ENT OPD