A. Acute otitis media – Explanation

The diagnosis can be seen with the examination of the ear. A red tympanic membrane
that is bulging is classical for otitis media. We know that the membrane is bulging

because there is a loss of light reflex. The light reflex (cone of light) is seen as a cone-
shaped reflection in the anterior inferior quadrant of the tympanic membrane. The

absence of the light reflex occurs when there is a distortion of the shape of the tympanic
membrane such as a bulging membrane due to an increase of inner ear pressure seen
in otitis media.

Acute otitis media in children
Acute otitis media is acute inflammation of the middle ear and may be caused by
bacteria or viruses.

Features

• Rapid onset of pain (younger children may pull at the ear)
• Fever

• Irritability
• Coryza
• Vomiting
• Often after a viral upper respiratory infection
• A red, yellow or cloudy tympanic membrane or bulging of the tympanic membrane.
• An air-fluid level behind the tympanic membrane
• Discharge in the auditory canal secondary to perforation of the tympanic membrane
• Perforation of the eardrum often relieves pain. This is because bulging of the
  tympanic membrane causes the pain.

OTITIS MEDIA VS OTITIS EXTERNA

If you are treating an otitis externa but suspect there may be a tympanic membrane
perforation, aminoglycosides ear drops are not the best choice as it is ototoxic. In these
cases, ciprofloxacin drops would be used however it is not currently licensed for this
indication.