Otitis Media (OM), Otitis Media with Effusion (OME, Glue Ear), and Chronic Suppurative Otitis Media (CSOM) are different forms of ear infections, each with unique features, diagnostic criteria, differential diagnoses, and management strategies.
Otitis Media (OM)
Diagnosis:
- Symptoms: Ear pain, irritability in children, fever, and hearing loss.
- Examination: Bulging, red, or inflamed tympanic membrane (eardrum) with limited mobility on pneumatic otoscopy. Fluid behind the eardrum and signs of middle ear inflammation.
- History: Rapid onset, often following upper respiratory tract infections.
Differential Diagnosis:
- Otitis Externa (swimmer’s ear)
- Eustachian tube dysfunction
- Foreign body in the ear
- Ear trauma
Management:
- Pain Management: Analgesics like paracetamol or ibuprofen.
- Antibiotics: Considered in severe cases, very young children, ATSI or if symptoms persist.
- Amoxicillin is first line
- Azithromycin is an option if refrigeration is an issue
- Follow-up: To ensure resolution and prevent complications.
Otitis Media with Effusion (OME, Glue Ear)
Diagnosis:
- Symptoms: Often asymptomatic, but may include hearing loss and a feeling of fullness in the ear.
- Examination: Retracted or neutral tympanic membrane with a dull or cloudy appearance. Air bubbles or fluid level may be seen.
- History: May follow acute OM or upper respiratory infections.
Differential Diagnosis:
- Acute OM
- Chronic Suppurative Otitis Media
- Eustachian tube dysfunction
Management:
- Observation: Many cases resolve spontaneously.
- Autoinflation: Encourage swallowing, yawning, or use of autoinflation devices.
- Antibiotics: If present for > 3 months Amoxicillin TDS for 2-4 weeks
- Surgical Intervention:
- Myringotomy (grommets) with tube insertion in persistent cases affecting hearing.
- +/- Adenoidectomy
Chronic Suppurative Otitis Media (CSOM)
Diagnosis:
- Symptoms: Persistent ear discharge (otorrhea) through a perforated tympanic membrane, hearing loss.
- Examination: Perforation of the tympanic membrane with active discharge. May have granulation tissue.
- History: Long-standing ear problems, often with a history of recurrent OM.
Differential Diagnosis:
- Acute OM with perforation
- External otitis
- Cholesteatoma
Management:
- Ear Cleaning: Aural toileting to remove purulent material.
- Topical Antibiotics: Ciprofloxacin 0.3% ear drops, 5 drops instilled into the affected ear, 12-hourly until the middle ear has been free of discharge for at least 3 days.
- Systemic Antibiotics: In cases of severe infection or when topical treatment fails
- Amoxicillin or Azithromycin
- Not settling after 4 months -> Trimethoprim/Sulfamethoxazole BD
- Surgical Management: For persistent cases, tympanoplasty or mastoidectomy may be required.
- Audiological Assessment: For assessing the impact on hearing.
- Hearing loss > 30dB -> Hearing aids
General Considerations for All Conditions
- Pain management with analgesics such as paracetamol or ibuprofen.
- Reassurance and education about the natural course of the disease.
- Prevention: Identifying and managing risk factors such as allergies, sinusitis, and environmental factors like tobacco smoke exposure.
- Hearing Assessment: Particularly in children, to evaluate the impact on language and development.
- Referral: Referral to an ENT specialist is important in cases of treatment failure, complications, or when surgical management is considered.
Pharmacological:
- Antibiotics: Reserved for specific cases, such as children under six months, severe cases, or where symptoms persist beyond 48 hours. Amoxicillin is typically the first-line choice.
- Topical Antibiotics: For cases of otorrhea with tympanic membrane perforation or otitis externa.
Follow-up:
- Review in 48 hours if no improvement or sooner if the condition worsens.
- Audiometry if there is persistent hearing loss after the infection has resolved.
Prevention and Community Health:
- Pneumococcal and Haemophilus influenzae type b (Hib) vaccinations.
- Public health measures to improve living conditions, reduce overcrowding, and promote breastfeeding.
ATSI Context
Ear infections in ATSI populations present a significant health burden, with a high prevalence of chronic suppurative otitis media (CSOM) and associated hearing loss, which can have long-term effects on education and social outcomes.
Additional Considerations for ATSI Patients:
- Antibiotics: A lower threshold for the initiation of antibiotics may be appropriate due to the higher risk of complications.
- Screening: Regular screening for ear disease in communities with high prevalence, ideally starting in infancy.
- Education: Education about early signs of ear disease and the importance of seeking timely medical care.
- Audiology: Ensuring access to audiological services and hearing devices when needed.
- Holistic Approach: Integration of care strategies within the community, involving Aboriginal Health Workers and continuous community-based care.
Management Strategies:
- Education: Community health education focusing on risk factors, hygiene, and the importance of early treatment.
- Vaccination: Pneumococcal and Haemophilus influenzae type b (Hib) vaccines can reduce the incidence of otitis media.
- Breastfeeding: Encouraged as it may reduce the risk.
- Environmental Health Interventions: Addressing overcrowding, improving living conditions, ensuring access to clean water and reducint passive smoke exposure.
Referral:
- Early referral to specialist ENT services for ATSI children with recurrent or chronic ear infections is crucial.
- Collaborative care plans that include ENT specialists, pediatricians, audiologists, and Aboriginal health services.
The approach to managing ear infections in ATSI populations requires cultural sensitivity, awareness of community dynamics, and a strong focus on primary health care engagement and health education. Early intervention, continuous follow-up, and community-driven strategies are essential to improving ear health in ATSI children and adults.