Treatment

1. Antibacterial therapy.

It is indicated in all cases with fever and severe earache. As the most common organisms are Strept. pneumoniae and H. influenzae, the drugs which are effective in acute otitis media are ampicillin (50 mg/kg/day in 4 divided doses), amoxicillin (40 mg/kg/day in 3 divided doses). Those allergic to these penicillins can be given cefaclor, co-trimoxazole or erythromycin. In cases where beta-Iactamase-producing H. influenzae or Moraxella catarrhalis are isolated, antibiotics like amoxicillin-clavulanate, augmentin, cefuroxime axetil orcefbdme may be used. Antibacterial therapy must be continued for a minimum of 10 days, till tympanic membrane regains normal appearance and hearing returns to normal. Early discontinuance of therapy with relief of earache and fever, or therapy given in inadequate doses may lead to secretory otitis media and residual hearling loss.


2. Decongenstant nasal drops.

Ephedrine nose drops (1%in adults and 0.5% in children) or oxymetazoline (Nasivion) orxylometazoline (Otrivin) should be used to relieve eustachian tubeoedema and promote ventilation of middle ear.

3. Oral nasal decongestants.

Psudoephedrine (Sudafed) 30mg twice daily or a combination of decongestant and antihistaminic(Triominic) may achieve drops which are difficult to administer inchildren.

4. Analgesics and antipyretics.

Paracetamol helps to relievepain and bring down temperature.

5. Ear toilet.

If there is discharge in the ear, it is dry-moppedwith sterile cotton buds and a wick moistened with antibiotic maybe inserted.

6. Dry local heat.
It helps to relieve pain.

7. Myringotomy

It is incising the drum to evacuate pus and isindicated when (a) drum is bulging and there is acute pain, (b) thereis an incomplete resolution despite antibiotics when drum remainsfull with persistent conductive deafness, (c) there is persistenteffusion beyond 12 weeks.

All cases of acute suppurative otitis media should be carefully followed till drum membrane returns to its normal appearance and conuctive deafness disappears.



Otalgia