Paediatrics - Queensland Health - Queensland Government

Ear problems
588
Acute otitis media with acute perforation
Discharging ear for less than 6 weeks - may be painful
Recommend
If seen in the first days treat see Acute otitis media
Always follow up to ensure perforation has healed
If discharge does not resolve by 14 days add ciprofloxacin drops and increase the
dose of oral amoxicillin
If discharge continues through an established perforation after 6 weeks of treatment
treat See Chronic suppurative otitis media (CSOM)
You may need to clean the discharge from the ear before you can see the drum, you
can usually do this by gently cleaning with a tissue spear
Background
Infection behind the eardrum may cause the drum to rupture
AOM with perforation occurs mainly in the first 18 months of life and effective
treatment will dramatically reduce the incidence of chronic suppurative otitis media
(CSOM) [1]
Ciprofloxacin drops are restricted on the Pharmaceutical Benefits Scheme to
treatment of chronic suppurative otitis media:
-- in an Aboriginal or a Torres Strait Islander person aged 1 month or older
-- in a patient less than 18 years of age with perforation of the tympanic membrane
-- in a patient less than 18 years of age with a grommet in situ
If not in an S100 community MO will need to obtain authority script
Related topics
Acute otitis media
Chronic suppurative otitis media (CSOM)
Controlled copy V1.0
Cleaning technique for ears with
discharge
Assessment of the ear
1. May present with
• Presents with onset of ear discharge for < 6 weeks
• Child may often have symptoms of acute otitis media - pain, fever
2. Immediate management Not applicable
3. Clinical assessment
• Obtain a complete patient history. See Assessment of the ear
• Document length of time perforation has been present
• Perform standard clinical observations
• Perform physical examination. See Assessment of the ear:
-- for otoscopic examination - you may need to clean the discharge from the ear
before you can see the drum, you can usually do this by gently cleaning with
a tissue spear
-- document the size and position of perforation on a diagram in the case notes
4. Management
• Give analgesia if required
• If not allergic to penicillin treat with amoxycillin
• If the discharge has been present for > 14 days the MO may increase the dose of
amoxycillin and order use of ciprofloxacin drops
• If the discharge has been present for >6 weeks the condition is chronic suppurative
otitis media (CSOM). Treatment is as for CSOM. Oral antibiotics are not indicated
Primary Clinical Care Manual 2011