{"id":3889,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/earinfectionsinchildren\/"},"modified":"2025-04-01T14:50:50","modified_gmt":"2025-04-01T13:50:50","slug":"earinfectionsinchildren","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-ent\/earinfectionsinchildren\/","title":{"rendered":"Ear infections in children"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Generally there are 3 categories of ear infections in children.<\/h4>\n\n\n\n<ol class=\"wp-block-list\">\n<li>&nbsp;(Recurrent) Acute otitis media &#8211; (R)AOM&nbsp;&nbsp; &nbsp; common<\/li>\n\n\n\n<li>&nbsp;Otitis externa &#8211; OE&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; &nbsp; common<\/li>\n\n\n\n<li>Chronic suppurative otitis media &#8211; CSOM&nbsp;&nbsp; uncommon<\/li>\n<\/ol>\n\n\n\n<p><strong>C.M. &amp; G.T. 01-04-25<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>(R)AOM<\/strong><strong>&nbsp;&#8211;&nbsp;&nbsp;<\/strong>If 4 or more episodes in 6 months or 6 or more episodes in a year refer ENT<\/p>\n\n\n\n<p><strong>OE<\/strong>&nbsp;&#8211; If no improvement despite appropriate management refer to ENT<\/p>\n\n\n\n<p><strong>CSOM<\/strong><strong>&nbsp;&#8211;&nbsp;<\/strong>If no improvement despite appropriate management and suspicion of CSOM refer to ENT<\/p>\n\n\n\n<p><strong>General Practice management<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>(R)AOM (Recurrent Acute Otitis Media<\/li>\n<\/ol>\n\n\n\n<p>Usually develops after\/with a URTI on the background of OME.<\/p>\n\n\n\n<p><strong>Symptoms:<\/strong>&nbsp;Pain, discharge, fever, malaise<\/p>\n\n\n\n<p><strong>Examination:<\/strong>&nbsp;dull, deep seated ache, drum red, bulging&nbsp;&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Management:<\/strong><\/p>\n\n\n\n<p>Usually supportive measures only<\/p>\n\n\n\n<p>If under 2 years old and\/or severely systemically unwell, consider oral antibiotics (amoxicillin)<\/p>\n\n\n\n<p>Refer urgently if complications (mastoiditis)<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">&nbsp;&nbsp;&nbsp; 2. Otitis Externa<\/h4>\n\n\n\n<p>Usually develops after swimming\/water exposure (but not always)<\/p>\n\n\n\n<p><strong>Symptoms:<\/strong>&nbsp;Pain, tender to touch \u2013&nbsp;<strong>particularly pressure on tragus or pulling backwards of pinna to examine canal<\/strong>; discharge, usually systemically well<\/p>\n\n\n\n<p><strong>Examination:<\/strong>&nbsp;Pain as above, discharge in canal, often oedematous canal, looks wet&nbsp;<\/p>\n\n\n\n<p><strong>Management<\/strong><\/p>\n\n\n\n<p>Take swab if not settling after initial management (might be fungal)<\/p>\n\n\n\n<p><strong>Topical<\/strong>&nbsp;antibiotic drops: Locorten Vioform, Gentisone HC<\/p>\n\n\n\n<p>If perforation suspected: Cilodex, Ciprofloxacin<\/p>\n\n\n\n<p>If fungal infection: long term (at least 6 weeks-2 weeks after symptoms have disappeared) course of Canestan<\/p>\n\n\n\n<p>Oral antibiotics do not work and are only indicated if the infection has spread to cause facial cellulitis.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">&nbsp; 3. CSOM Chronic suppurative otitis media<br><\/h4>\n\n\n\n<p>Either due to chronic perforation or cholesteatoma<\/p>\n\n\n\n<p><strong>Symptoms<\/strong>: Recurrent infection, often very smelly, often painless without other symptoms. Initial response to topical\/oral treatment short lived-frequent relapses<\/p>\n\n\n\n<p><strong>Examination:<\/strong>&nbsp;Copious smelly discharge, often little else to see&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Management:<\/strong><\/p>\n\n\n\n<p><strong><\/strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Topical and oral antibiotics-if no resolution or recurrence:<\/p>\n\n\n\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Refer to ENT OPD<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Generally there are 3 categories of ear infections in children. C.M. &amp; G.T. 01-04-25<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4246,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[167],"class_list":["post-3889","page","type-page","status-publish","hentry","category-earinfectionschildren"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entpaediatric\/earinfectionschildren\/\" rel=\"tag\">Ear infections in children<\/a>","rttpg_excerpt":"Generally there are 3 categories of ear infections in children. C.M. &amp; G.T. 01-04-25","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3889","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3889"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3889\/revisions"}],"predecessor-version":[{"id":23595,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3889\/revisions\/23595"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4246"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3889"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3889"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}