Acute otitis media | Right Decisions

Right Decisions
NHS Grampian paediatric unscheduled care
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Assessment for a suspected diagnosis
Acute otitis media

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Polyfill.io vulnerability

28 june 2024

Our eHealth team advised us yesterday of an international vulnerability relating to polyfill.io . This domain has become compromised and is spreading malware through a widespread supply chain attack, estimated to affect over 110,000 websites including major websites such as the BBC. The Polyfill site offered widely used bits of code for older browsers that allowed the use of modern Javascript features. Such code makes the work for web developers easier and allows compatibility with a broader range of browsers.

Websites that have used the Javascript code from Polyfill have been urged to remove such code immediately. The change occurred after a suspected Chinese firm purchased the domain in early 2024.

Tactuum have identified and are now testing a fix to remove all Polyfill code from the RDS site.. They will be deploying the fix on Monday 1 July along with other planned fixes and amendments. I will notify you of the timing of the deployment as soon as possible.

In the meantime, please ensure that you have up-to-date anti-virus software installed on your machines and personal devices.

Once vital signs have been checked and sepsis excluded, for a child presenting with symptoms suggestive of acute otitis media:

Painful ear
History of fever
Ear discharge

Consider the following management for pain and fever:

Regular paracetamol or ibuprofen
Ensure sufficient fluid intake and urine output

Review patient if there is significant worsening at any time.

Typical duration of symptoms is 4 days but 20% of children have symptoms lasting more than one week.

Antibiotics are not indicated in the majority of children presenting with acute otitis media:

NNT = 33 for reducing tympanic perforation and 11 for reducing acute otitis media in unaffected ear
NNH = 14 for adverse event due to antibiotics

However in children < 2 years with bilateral acute otitis media consider:

First line – Amoxicillin for 5 days (see cBNF)
Second line – Erythromycin for 5 days (see cBNF)

Last reviewed: 06/02/2018

Version: 0.3

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