ABSTRACT
The aetiology is viral in many cases, e.g. respiratory syncytial virus, adenovirus, influenza, but a number of bacterial pathogens may also be responsible, including Streptococcus pneumoniae, Haemophilus influenzae, group A ß-haemolytic streptococcus. Severe otalgia is accompanied by fever, irritability and a bulging tympanic membrane with loss of its light reflex. Purulent discharge may appear if the drum ruptures. Complications include chronic suppurative infection and secretory otitis media with effusion. Meningitis, mastoiditis and cerebral abcess may rarely complicate an acute bacterial episode. Treatment with antibiotics (penicillin, amoxycillin, erythromycin or trimethoprim) is appropriate, since clinical distinction between viral and bacterial otitis media is difficult. Paracetamol may be given for fever and pain.
