Chapter 49: Upper Respiratory

Question 1

True or False:

The most common reason for which children in the US receive antibiotics is AOM.

Answer 1

True:
An estimated 10.3 million visits annually are coded for AOM. Office visits for a OM and children younger than age 18 years as measured by the US national ambulatory medical care survey decline from 34.4 out of 100 in 1997 to 24.66 out of 100 in 2007.
The cost of treating AOM in the United States includes office visit an antibiotics is $2.88 billion based on the 2009 medical expenditure panel survey.

Question 2

True or false?

The Hallmark symptom of OM is bilateral ear pain.

Answer 2

False

The hallmark symptom of OM is ear pain, often unilateral. Patients may also complained of hearing loss in the affected ear.

Question 3

Other possible symptoms of AOM

Answer 3

ear tugging/poking
hearing loss in the affected ear
fever
tinnitus
dizziness
unsteady gait or balance problems
V/D (in young children)

Question 4

Classic objective signs of AOM

Answer 4

Mod-Severe bulging TM or new onset of otorrhea not due to acute otitis externa
Mild bulging of the TM and less than 48 hour onset of ear pain or intense erythema of the TM
No diagnosis of AOM in children who do not have middle ear effusion (MEE)

Question 5

Otitis Media Effusion is:

Answer 5

Fluid in the middle ear without signs or symptoms of acute illness

Question 6

MEE stands for:

Answer 6

Middle ear effusion

Assessed by observing white or yellow fluid, observing the air/fluid level, observing air bubbles, or noting decreased TM movement via pneumatic otoscopy.

Question 7

Bullous Myringitis

Answer 7

A thin walled bulla in the ear, a painful form of AOM.

Question 8

AOM occurs when:

Answer 8

When there is a combination of an eustachian tube dysfunction, blocking the flow of secretions from the middle ear to the pharynx, and negative pressure developing in the middle ear, which causes reflux of bacteria into the middle ear space.

Question 9

Risk factors for children to AOM

Answer 9

• Down Syndrome
• URIs
• cleft palate
• HIV infection
• Eskimo or Native American heritage
• Bottle fed infants
• Children who live with tobacco smokers

Question 10

Most common pathogens of AOM

Answer 10

S. pneumoniae, H. influenzae, and M. catarrhalis

Question 11

Treatment goals of AOM

Answer 11

Treatment Goals: alleviate ear pain and fever, eradicate infection, prevent complications, and avoid unnecessary antibiotic use

Question 12

True or False?

The majority of AOM cases resolve spontaneously.

Answer 12

True.

Question 13

Non-Pharmacologic Treatment of AOM

Answer 13

Watch and wait in patients with non-severe illness for 48-72 hours after diagnosis to see if self-resolves.
Heat to affected ear for comfort

Question 14

Treatment for symptoms of AOM

Answer 14

Symptomatic treatment:
Antipyretics
Acetaminophen – usual dosing 325-650 mg by mouth every 4-6 hours as needed (Maximum 4,000 mg/day)
Children: 10-15 mg/kg every 4-6 hours as needed
Ibuprofen 200-400 mg by mouth every 4-6 hours as needed
Children 5-10 mg/kg every 6-8 hours as needed

Question 15

The first line antibiotic therapy for AOM is:

Answer 15

1st line: 
Amoxicillin
Amoxicillin/clavulanate 
Mild allergy to penicillins: cephalosporins (e.g. ,cefdinir, cefuroxime; ceftriaxone)
Severe allergy to beta-lactams:
Azithromycin, clarithromycin

Duration: 5-7 days for mild infections, 10 days for severe infections