ENT Otitis Media

Question 1

A 9-month-old boy, fully immunised, is found to have unilateral otitis media which has spontaneously perforated. What is the most likely microorganism responsible?

Question 1Select one:

a.
Group A Streptococcus pyogenes

b.
Non-typable Haemophilus influenzae

c.
Haemophilus influenzae Group B

d.
Streptococcus pneumoniae

Answer 1

Non-typable Haemophilus influenzae

unilateral + perf makes this likely to be bacterial

Question 2

A four-year-old boy, Jack, is referred to you after his second episode of otitis media in the past 12 months. He completed a 5-day course of antibiotics for the most recent infection three days ago. On examination both tympanic membranes are now dull but not inflamed. An audiogram reveals a flat tympanogram and 20 decibels of hearing loss in both ears. What is the best treatment option for Jack at this point?

Question 2Select one:

a.
Oral decongestant syrup

b.
Urgent grommet insertion

c.
Incision and drainage

d.
Follow up in six weeks time

Answer 2

Follow up in 6 weeks time

He is in resolution phase, need to check if eardrum+ hear improving

Question 3

A 9-month-old boy, whose immunizations are up to date, has had a sore throat and runny nose, and has been pulling at his ears. On examination he has bilateral pink-red retracted eardrums with no light-reflex. What is the most likely pathogen to cause this scenario?

Question 3Select one:

a.
Strep. pyogenes

b.
Strep. pneumoniae

c.
Human rhinovirus

d.
Haem. influenzae

Answer 3

Human rhinovirus

signs of viral infection

Question 4

A 2 year-old boy, Sam, has had recurrent ear infections, treated in your surgery with antibiotics. His mother is concerned about his speech and hearing as he only has about 10 words at this stage and has not started putting words together. On examination you find bilateral retracted eardrums with signs of an air fluid level. You request a tympanogram which confirms bilateral Otitis Media with Effusion.

What should you do to manage this child’s issues at this point?

Question 4Select one:

a.
Prescribe 10 days’ amoxicillin-clavulanate

b.
Refer to Speech-Language Therapist

c.
Refer to ENT for ventilation tube insertion

d.
Request an audiology screening test

Answer 4

Prescribe 10 days’ amoxicillin-clavulanate

Then follow up to see if hearing ok within 3 months