Acute otitis media

Background: Acute Otitis Media is a bacterial infection of the middle ear and commonly occurs after a viral URTI.  It is categorised by unilateral otalgia and hearing loss in the absence of discharge.  Discharge occurs with resolution of the pain when there is spontaneous rupture of the tympanic membrane.  The resultant perforation should seal without intervention.  Most cases should be managed within primary care.

Secondary care referral is not required unless complications or sepsis is suspected.

How to assess:

Examine the ear – if the tympanic membrane is normal then mastoiditis is unlikely

Examine the mastoid bone (posterior to ear) – does the pinna protrude forwards compared to the other side, is there erythema, is there fluctuance?

Referral guidance:

Oral antibiotics in accordance with NICE & local prescribing guidelines Infection Management in Adults, Primary Care, NHSGGC (166) and Recommendations: Otitis media (acute): antimicrobial prescribing, NICE

Emergency referral to ENT if concerned regarding mastoiditis

Complications:

Post-auricular lymphadenopathy can become tender and/or erythematous and so can occasionally be confused for mastoiditis.

Mastoiditis is a complication of acute otitis media. It presents with a history of otalgia and hearing loss from acute otitis media, followed by sepsis, pinna protrusion and pain over the mastoid process. Patients with suspected mastoiditis should be referred to ENT as an Emergency for consideration of imaging and/or surgical management.  However, if the tympanic membrane is normal, then the patient is unlikely to have acute mastoiditis. Another common cause of otalgia and post-auricular pain is otitis externa with post-auricular lymphadenopathy.