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3.03 Otitis Media


Presentation

Adults and older children will complain of ear pain. There may or may not be accompanying symptoms of upper respiratory infection. In younger children and infants, parents may report that their child is irritable and sleepless, with or without fever, and possibly pulling at his ears. The tympanic menbrane is inflammed and may be bulging with loss of landmarks. It may be dull or opacified with reduced mobility on pneumatic otoscopy. and may or may not be accompanied by otorrhea.

What to do:

What not to do:

Discussion

Most otitis is caused by a viral infection, and most patients do well regardless of the antibiotic chosen. Despite the increase in antimicrobial resistance of community-acquired Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis and the plethora of alternative antibiotics available, amoxicillin remains the drug of choice, because it concentrates in middle ear fluid.

References:


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Craig Feied, MD
Mark Smith, MD
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Michael Gillam, MD