Clinical quiz: Managing otitis media in children

Otitis media is one of the most common reasons children present to primary care. While many cases are self-limiting, the condition can cause significant pain, parental anxiety and diagnostic uncertainty. Nurses face the added challenge of balancing the avoidance of unnecessary antibiotic therapy with the importance of recognising those children who may require prompt treatment or further assessment.

Our latest clinical quiz explores the key features of otitis media in children, when referral is required and NICE recommended approaches to safe, effective management. Work your way through the cases and questions to test your knowledge of management of otitis media in children.

Click start below to begin the quiz.

Note all cases are hypothetical and developed for educational purposes

<section data-block="MultipleChoice"> <h3>You are seeing an 18-month-old boy who has been brought in to the surgery because he has been pulling at his right ear for the last 24 hours and saying ‘ow’ when he does so. The pain improves with paracetamol, but his mother wonders if he has an ear infection and needs antibiotics. On examination his right tympanic membrane is red and dull, with some slight bulging. Which of the following features would make you more likely to prescribe antibiotics? Select all that apply</h3> <ul> <li>A history of discharge from the ear since the pain has started.</li> <li>Signs of otitis media in both ears.</li> <li>A temperature of 37.8°C.</li> <li>A co-existing sore throat.</li> </ul> </section> <section data-block="SingleChoice"> <h3>The boy doesn’t have any red flags – he presents as a well, happy child who is busy exploring your consultation room; the paracetamol that his mother gave him a couple of hours ago has clearly done the trick. You explain to his mother that his AOM should resolve within three days and that she should continue using paracetamol and/or ibuprofen for pain and only needs to bring him back if improvement hasn’t started at three days, or if he becomes systemically unwell. She asks if he can have any ear drops – what do you say?</h3> <ul> <li>No, none are indicated in this situation.</li> <li>You can give some antibiotic ear drops.</li> <li>You can give some analgesic ear drops.</li> <li>You can give some olive oil ear drops to prevent the build up of wax, which may worsen his pain.</li> </ul> </section> <section data-block="SingleChoice"> <h3>The child’s mother understands that the infection should get better on its own, but she has read online that treating with antibiotics is important for preventing complications such as hearing loss. Is this an indication for giving oral antibiotics?</h3> <ul> <li>Yes</li> <li>No</li> </ul> </section> <section data-block="SingleChoice"> <h3>Another patient in your clinic also has unilateral otitis media – she is a three-year-old girl with cystic fibrosis, which is managed by your local children’s hospital. She is systemically well, with no otorrhoea and her ear pain started two days ago. How would you manage her?</h3> <ul> <li>Regular analgesia only.</li> <li>Back-up antibiotics to be started if there is no improvement in three days.</li> <li>Immediate antibiotics.</li> </ul> </section> <section data-block="MultipleChoice"> <h3>If treating a child for AOM, which of the following regimens are consistent with NICE guidance? Select all that apply</h3> <ul> <li>Clarithromycin for someone with no allergies.</li> <li>Amoxicillin for someone with no allergies.</li> <li>Co-amoxiclav for someone with a penicillin allergy.</li> <li>Clarithromycin for someone with a penicillin allergy.</li> <li>Co-amoxiclav as a second choice if symptoms worsen after 2-3 days on a different antibiotic.</li> </ul> </section> <p>  <div id="article_leaderboard2" class="article-lb mb-4 widget_text widget adbanner mpu d-none d-md-none d-lg-block "> <div class="textwidget custom-html-widget">  <div id="article-lb"><script> googletag.cmd.push(function() { googletag.display("article_leaderboard2"); }); </script></div> </div> </div> <p>  <p>  <p><strong>Related Article: </strong> <a id="related_article_link_2" href="https://www.nursinginpractice.com/clinical/vaccination-and-infection/vaccine-pop-ups-aim-to-fight-flu-wildfire-among-children/">Vaccine pop-ups aim to fight flu ‘wildfire’ among children</a> <p>  <p>  <p>  <p>

Dr Toni Hazell is a GP in north London

Clinical quiz: Managing otitis media in children

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