Page 144 - 2025 Ranger Medic Handbook

Otitis Media
(Middle Ear Infection)
DEFINITION: Eustachian tube dysfunction, viral infection, or bacterial infection of middle ear.
S/Sx: Ear pain, +/– fever, decreased hearing, sensation of ear fullness; erythema and bulging of TM are hallmark signs
but loss of landmarks typically seen in adults, increased pressure may cause TM rupture and discharge; often noted with
accompanying URI symptoms, recent air travel, or recent ascent to altitude.
MANAGEMENT:
1. Acetaminophen 1,000mg PO q6hr AND/OR ibuprofen 800mg PO tid prn pain AND pseudoephedrine 60mg qid.
2. Oxymetazoline nasal spray 2 squirts per nostril bid (max 3 days).
SECTION 3 875/125mg PO bid × 10 days OR azithromycin 500mg PO initially followed by 250mg PO qd × 4 days OR ceftriaxone
3. If grossly apparent, or no resolution in 1–2 days, or bacterial, then add antibiotics: amoxicillin/clavulanate acid
250mg IM single dose.
DISPOSITION: For uncomplicated cases, no evacuation is necessary. Routine evacuation for complicated cases not
responding to therapy.
SPECIAL CONSIDERATIONS:
1. Increased pressure in the middle ear may cause intense pain and may result in rupture of the tympanic membrane
(characterized by sudden decrease in pain and drainage from ear canal).
2. If water immersion is anticipated, use ear plugs to prevent cold water entry, which will cause vertigo.

130 SECTION 3 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) & SICK CALL