1 Chapter 13: Acute suppurative otitis media and acute mastoiditis ...

Treatment of acute suppurative otitis media
Treatment of acute suppurative otitis media is considered under the following
headings:
(1) curative
medical
general
analgesics
topical
antibiotics
[decongestants]
surgical - myringotomy
(2) [prophylactic]
(3) treatment of associated conditions
(4) treatment of complications.
The square brackets indicate treatment modes not generally considered to be
appropriate.
Curative
Medical treatment
General
Both children and adults are best managed in bed in the acute phase, in a warm room,
of adequate humidity to maintain ciliary function. Febrile and toxic children will need no
persuasion to stay in bed; afebrile children can be allowed up but kept indoors. As in any
infective illness, nourishment and fluid intake must be adequate, and supplementary vitamins,
especially C, can be added if the patient's normal diet is thought to be inadequate. Some
patients, both children and adults, are better managed in hospital, depending on the severity,
length of history, response to previous treatment, and other factors such as association with
diabetes or other illness. Hospitalization provides the opportunity for frequent observation of
the general and local condition, and for investigations, if complications are suspected or
surgery is considered.
Analgesics
These must be given in adequate dosage and with sufficient frequency to control pain.
Topical
When otorrhoea is present the discharge should be gently mopped with dry sterile
cotton wool or sucked from the canal, as often as it recurs. A piece of cotton wool can be
placed at the orifice of the ear canal to prevent the discharge running down and excoriating
the skin of the ear lobe.
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