Acute otitis media b
Red (erythematous) ± bulging TM (tympanic membrane)
Use oral amoxicillin.
If symptoms persist after
days or if hx of recent antibiotic usage, then give amoxicillin + clavulanate.
Painful vesicles in TM (tympanic membrane) + red (erythematous) TM ± bulging TM
Rx is the same as above, as the causative organism is similar to acute otitis media.
Additional causes include Mycoplasma pneumoniae, viral (e.g., influenza, herpes zoster), etc.
Serous otitis media (a.k.a. otitis media with effusion) This might be a complication of eustachian tube dysfunction or sequelae of acute otitis media.
Dull hypomobile TM (tympanic membrane) ± airfluid level in tympanic cavity
Best diagnostic test is tympanometry, which uses a probe to detect reflected sound waves. Stiff middle ear or TM reflects more sound.
Chronic otitis media MC causes are Pseudomonas and S. aureus.
Recurrent or persistent ear discharge (major differentiating factor from acute otitis media is hx of > 6 weeks)
Calcific patches + perforation
In uncomplicated cases, use ear irrigation with topical antibiotics (e.g., ciprofloxacin).
In complicated cases (e.g., with mastoiditis, systemic symptoms), do CT scan and give systemic antibiotics. Surgery might also be needed.
Cholesteatoma (keratinized desquamated epithelial collection, with inflammatory and infectious component that can spread and destroy bones) May be primary (due to chronic eustachian tube dysfunction) or secondary (due to acquired TM perforation)
Presents similarly to chronic otitis media, but otoscopic findings are different
Debris, granulation tissue, and inflammatory polyps
NSIM is CT to determine the extent of disease.
Rx: surgical removal/ debridement.
Eustachian tube dysfunction Look for hx of recent upper respiratory tract symptoms which can cause eustachian tube inflammation and edema. If persistent, look for secondary causes such as:
Fullness and pain in ear, worsened by chewing food. Audible pop might also be heard when the tube opens intermittently.
Treat underlying cause.
Nasal decongestants, hydration.