Acute Otitis Media

Question 1

What is acute otitis media (AOM)

Answer 1

Middle ear infection from nasopharyngeal pathogens
*air contained spaces of temporal bone, middle ear cleft, pneumatized mastoid air cells

Question 2

What are the common pathogens causing AOM

Answer 2

1. Strep pneumoniae
2. H. Flue
3. Strep Pyogenes

Question 3

What is AOM often precipitated by

Answer 3

Viral URI
1. Eustachian tube obstruction
2. Accumulation of fluid / mucus
3. Fluid becomes infected

Question 4

When is AOM more common

Answer 4

Winter months
*can be seen in children and adults

Question 5

What are the signs of AOM

Answer 5

1. Acute onset (URI0
2. Otalgia
   *pain decreases after otorrhea
3. Fever, ear pressure, congestion
4. Mastoid tenderness
5. Decreased hearing

Question 6

What will be found on PE

Answer 6

1. Erythematous
2. Opaque
3. Bulging
4. Decreased mobility
5. Purulent / fluid levels

Question 7

What is the first line tx of AOM

Answer 7

Amoxicillin 1g orally every 8 hours for 5-7 days

Question 8

What to use if resistant

Answer 8

Amoxicillin-clavulanate 875/125mg every 12 hours for 5-10 days

Question 9

What are other treatment options for AOM

Answer 9

Cefuroxime 500mg or cefpodoxime 200 mg every 12 hours for 5-7 days

Question 10

What are the complications of AOM

Answer 10

1. Mastoiditis
2. Meningitis
3. Osteomyelitis of skull bones

Question 11

What is a tympanocentesis and when is it recommended

Answer 11

A culture to assesses for fungal or aerobic / anaerobic species
(consider for immunocompromised and persistent AOM

Question 12

What is recurrent acute otitis media

Answer 12

3 or more episode of AOM in 6 months or 4 episodes in 12 months

Question 13

What is the ATB prophylaxis for recurrent AOM

Answer 13

Over 1-3 months
1. Once daily sulfamethoxazole (500mg) or amoxicillin (250 or 500mg)

Question 14

What is used if the ATB prophylaxis for recurrent AOM is ineffective

Answer 14

ENT referral
1. Placement of ventilation tubes
2. Tonsillectomy
3. Adenoidecotmy