Acute otitis media most commonly occurs in young paedi-atric patients less than 6-7-year old. It typically occurs, following an upper respiratory tract infection (URTI), as ascending infection through the Eustachian tube. The natural course of acute otitis media is best described in four stages: hyperaemic, inflammatory, suppurative and resolution phases. In the hyperaemic phase, the patient has otalgia without hearing loss and otoscopy reveals a hyperaemic eardrum. The inflammatory phase that follows is characterized by increasing otalgia and hearing loss. Fever is usually present at this phase. Otoscopy reveals a hyperaemic eardrum and middle ear effusion. The disease reaches a climax at the suppurative phase. The patient often becomes irritable because of intense otalgia and hyperpyrexia is frequently present. Otoscopy reveals pus collecting behind a bulging and intensely hyperaemic eardrum. The eardrum is now under severe tension and may rupture spontaneously. Once the eardrum ruptures, the condition enters the resolution phase. All the symptoms especially otalgia resolves rapidly.
The natural course of acute otitis media may be altered by therapy. The underlying URTI will need to be treated. Nasal decongestant is useful to reduce the oedema of the Eustachian tube. A second-generation cephalosporin is a logical choice for initial antibiotic therapy. Acute otitis media usually settles quickly with medical therapy. If the facial nerve canal is dehiscent, facial nerve palsy may very rarely complicate the condition. If this occurs, myringotomy is indicated to hasten resolution of the suppurative phase and recovery of the facial nerve function.
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