Acute otitis media
ACUTE OTITIS MEDIA
ELIGIBILITY:1 For children aged 1 to 17 years
EXCLUDE: Recurrent acute otitis media (3 or more episodes in 6 months or 4 or more episodes in 12 months), pregnant individuals under 16 years
ACUTE OTITIS MEDIA (AOM) is defined as the presence of inflammation (redness and swelling) in the middle ear, associated with a build-up of fluid behind the ear drum which presents with signs and symptoms of an ear infection.10 AOM is most common in children aged between 0-4 years and is usually caused by viruses like colds and flu.10,11 In 60% of cases, children suffering with AOM start to improve within 24 hours without antibiotic treatment, and most people recover within 3 days.10,11 Those suffering with a bacterial infection may be eligible for the Pharmacy First service.
A dad and his 1-year-old daughter Sienna approach you at the pharmacy counter. Sienna looks upset and is tugging her right ear. He tells you that she has not been herself lately; she has been crying, not feeding well, and has been indicating pain in her ear, so he called 111 as he was concerned. They advised him to visit this pharmacy where the pharmacist should be able to assess Sienna through the Pharmacy First service.
You inform the pharmacist, who has been expecting Sienna, and they are led to the consultation room.
While they are in the consultation room you consider the signs and symptoms she presented with and if she had any red flag symptoms.
Sienna appears with some of the signs and symptoms of AOM:1,11
Earache
Fever
Nausea
Lack of energy
Slight hearing loss
As a young child, Sienna also shows the following:11
Rubbing or tugging her ear
Not reacting to sounds
Irritable and restless
Losing her appetite
Losing her balance
Sienna does not appear to have any red flag symptoms:1,11
Signs of a serious illness, e.g. meningitis or sepsis
Severe pain
Regular ear infections
Headache
Nausea and vomiting
Photophobia
Mottled skin
Click the button to find out whether this customer is eligible for referral.
REFERRAL OUTCOME
Referred to the Pharmacy First service
A short while later, they leave the consultation room and dad has been given some antibiotics for Sienna. The pharmacist asks you to offer them some self-care advice, some prevention tips and some OTC products for symptom relief that they can use in conjunction with the treatment.
PREVENTION TIPS
You tell dad that: “You can’t always prevent ear infections, particularly inner ear infections caused by colds and flu; however, there are some things you can try:”10,11
Make sure Sienna is up to date with vaccinations
Keep her away from smoky environments
Avoid giving her a dummy as she is older than 6 months
Avoid feeding her while she is lying flat on her back
SELF-CARE ADVICE & PRODUCT RECOMMENDATIONS
Dad should adhere to the following advice to aid Sienna’s recovery:10,11
Paracetamol or ibuprofen can be used to relieve the pain and fever – it’s important to read the dosage instructions carefully and check suitability with the pharmacist
Place a warm cloth over the affected ear – this can help to relieve pain
Remove any discharge by wiping the ear with cotton wool
Once her earache and fever has settled she should be able to return to nursery
Complete the care
Dad purchases some ibuprofen suspension. You advise him about the correct dosage according to Sienna's age and weight and remind him how to administer and store her antibiotics. You reassure him that ear infections are very common in young children and she will likely improve with her treatment. If he has any more questions, he can come back for more advice.
KEY LEARNING POINT
It’s important to remember the differences when offering advice and products to adults and children. Product advice and self-care recommendations are often based on the child’s age and weight, amongst other factors. It is important to offer personalised, relevant advice to parents, who are often quite worried and need reassurance.