Paediatrics - Queensland Health - Queensland Government

Ear problems
Acute otitis media (AOM)
Non-discharging painful ear
Recommend
Consult MO immediately if child is < 3 months of age, who is sick or hot, or meets
any of the other criteria outlined at beginning of paediatric section
All children with AOM should be reviewed after four to seven days of treatment or
earlier if deterioration [1]. A second review should take place after completion of
therapy [1]
Health clinics have targeted hearing health programs to focus on day care and pre
school children where intervention may prevent ear damage and hearing loss
Personal hygiene in children - washing hands and face is important
Background
In some rural and remote Aboriginal communitites complications of otitis media
are much more common. They include tympanic membrane perforations, CSOM,
OME and mastoiditis. This is the reason that antibiotics are recommended in these
children, while in low risk populations the advantage of antibiotics is small
Related topics
Upper respiratory tract infection - child
Pneumonia
Acute asthma
Bronchiolitis
Assessment of the ear
1. May present with
• A history of acute onset of signs and symptoms
• Young child may present with irritability, disturbed sleep, pulling at ears, sometimes
vomiting and diarrhoea
• Fever or upper respiratory symptoms
• Pain clearly originating from the ear
• Some children will not have pain but a red bulging drum is found on routine exam
2. Immediate management Not applicable
3. Clinical assessment
• Obtain a complete patient history. See Assessment of the ear
• Perform standard clinical observations
• Perform physical examination. See Assessment of the ear Look for inflammation
with a red bulging tympanic membrane and loss of light reflex
4. Management
• Provide adequate and regular analgesia
See Simple analgesia back cover
• Consult MO if child:
- - < 3 months of age, who is sick or hot
-- temperature over 38° C or below 36°C
-- has any rash, increased respiratory rate or respiratory distress or meets any
of the other criteria as outlined at beginning of paediatric section - this child
needs to be managed as a septic infant
• Spontaneous resolution of AOM is unlikely in high risk populations therefore if not
allergic to penicillin treat with amoxycillin [1]
Primary Clinical Care Manual 2011 Controlled copy V 1.0 583