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Paediatrics finals > Otitis media > Flashcards

Otitis media Flashcards

1
Q

What is acute otitis media?

A

Infection of the middle ear resulting from nasopharyngeal organisms migrating through the eustachian tube

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2
Q

Describe how the anatomy of children’s eustachian tube makes acute otitis media more likely

A

Immature
short, straight and wide
Only becomes oblique as the child grows

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3
Q

List some common bacteria which cause acute otitis media

A

S.pneumoniae (most common)
H.influenza
M.catarrhalis
S.pyogenes

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4
Q

List some common viruses which cause acute otitis media

A

Respiratory syncytial virus (RSV)

Rhinovirus

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5
Q

List some risk factors for acute otitis media

A 
Age (peak 6-15months) 
Gender (boys) 
Parental smoking 
Bottle feeding
Craniofacial abnormalities
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6
Q

What is recurrent acute otitis media commonly associated with?

A

Use of pacifiers
Those fed supine
First AOM episode when <6mo

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7
Q

Describe the typical presenting complaint of acute otitis media in children

A 
Pain
Malaise
Fever
Coryzal symptoms 
Tugging or cradling the ear
Off food
Irritable
Vomiting 
Extreme pain which suddenly resolves followed by discharge from the ear is a perforation TM
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8
Q

What may be seen on otoscopy in acute otitis media?

A

Erythematous and bulging tympanic membrane
Tear in the TM if perforated
Purulent discharge in the auditory canal if perforated

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9
Q

How is acute otitis media diagnosed?

A

Most can be diagnosed clinically
Bloods - FBC and CRP - confirm infection, blood cultures if suspecting sepsis
Swabs of discharge for MC&S

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10
Q

Describe how acute otitis media is managed

A

Majority spontaneously resolve after 1-3days
Simple analgesics
Watch and wait with delayed prescription antibiotics (if still unwell at 4 days)
If worrying features then IV antibiotics

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11
Q

When should oral antibiotics be considered for acute otitis media?

A

Systemically unwell but not requiring admission
Known RF for complications - congenital heart disease or immunosuppression
Unwell for >4days with no improvement
Discharge from the ear
Children <2yo with bilateral infections

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12
Q

When should inpatient admission for acute otitis media be considered?

A

All children <3months with temp >38
All children 3-6 months with temp >39
Evidence of AOM complication or sepsis
Cochlear implant - need to be seen by specialist

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13
Q

List the complications of acute otitis media

A 
Mastoiditis 
Meningitis 
Facial nerve paresis
Intracranial abscess
Sigmoid sinus thrombosis
Chronic otitis media
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14
Q

When examining a child with acute otitis media what else should be examined?

A

7th cranial nerve - as it runs through the middle ear
Cervical lymphadenopathy
Mastoid

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15
Q

Describe mastoiditis

A

Common Intratemporal complication of AOM

Inflammation and infection spreading to the bone of the mastoid air cells

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16
Q

How does mastoiditis present?

A

Boggy, erythematous swelling behind the ear

If left untreated may push the pinna forward

17
Q

How should suspected cases of mastoiditis be managed?

A

Admit for IV antibiotics (co-amoxiclav or ceftriaxone), bloods (FBC, CRP), swabs for MC&S and CT head and mastoid with contrast (/MRI) if not improving after 24hrs IV antibiotics

18
Q

What are the complications of mastoiditis?

A 
Meningitis 
Sub-periosteal abscess 
Bone necrosis 
Facial nerve palsy 
Hearing loss - conductive and sensorineural 
Labyrinthitis 
Cranial osteomyelitis 
Dural sinus thrombosis
19
Q

What is the definitive management of mastoiditis?

A

Mastoidectomy

20
Q

What are the mastoid air cells

A

Collection of air filled spaces located in the mastoid process of the temporal bone

21
Q

How do the mastoid air cells communicate with the middle ear?

A

Small canal called the aditus to mastoid antrum

22
Q

Describe the formation of a sub-periosteal abscess

A

Infection in the mastoid air cells
Breakdown of fine trabeculae along with collection of pus in the mastoid antrum
Under pressure and results in localised bone necrosis which can spread to form the sub-periosteal abscess

23
Q

Where can abscesses caused by mastoiditis be found?

A

Behind the pinna - Macewen’s triangle
Superior to the pinna towards the zygomatic bone
Over the squamous temporal bone

24
Q

List the risk factors for mastoiditis

A

Young children
Immunocompromised
Pre-existing cholesteatoma

25
Q

What signs on examination of mastoiditis indicate advanced disease?

A

6th or 7th CN palsy

Facial pain due to CN5a (ophthalmic branch)

26
Q

When can IV antibiotics for mastoiditis be switched to oral?

A

If child is improving and is no longer pyrexic

27
Q

How long should oral antibiotics for mastoiditis be continued for?

A

14 days

28
Q

What is otitis media with effusion?

A

Build up of viscous inflammatory fluid in the middle ear

29
Q

What type of hearing loss does otitis media with effusion result in?

A

Conductive

30
Q

What causes otitis media with effusion?

A

Eustachian tube dysfunction - anatomy in children means infection more likely
Chronic inflammatory changes

31
Q

List the main risk factors for otitis media with effusion

A

Bottle fed
Parental smoking
Atopy
Genetics - mucocillary disorders (CF) and craniofacial disorders (Downs)

32
Q

Describe the clinical features of otitis media with effusion

A 
Conductive hearing loss 
Sensation of pressure
Popping/crackling noises 
Vertigo 
Disequilibrium
33
Q

Describe otoscopy findings of otitis media with effusion

A

Dull tympanic membrane
Loss of light reflex - fluid in middle ear
Normal external auditory canal

34
Q

What investigations are done for otitis media with effusion

A

Clinical diagnosis
Pure tone audiometry - conductive hearing loss
Tympanometry - reduced membrane compliance - type B tracing

35
Q

In adults what must be done when otitis media with effusion diagnosed?

A

Flexible nasendoscopy to rule out post-nasal space masses

36
Q

Describe the management of otitis media with effusion

A

Active surveillance in outpatient setting
50% resolve after 3 months
If not resolved after 3 months - hearing aid insertion or myringotomy and grommet insertion

37
Q

Who does NICE recommend grommet insertion for?

A

> 3months persistent bilateral OME and hearing level<25-30dBHL in the better ear

38
Q

What surgery should be considered for children with persistent OME and multiple grommets already inserted?

A

Adenoidectomy

Paediatrics finals (37 decks)

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