Acute otitis media passmed Flashcards
How common is Acute Otitis Media in young children?
Acute otitis media is extremely common in young children, with around half having three or more episodes by the age of 3 years.
Describe the pathophysiology of Acute Otitis Media.
Acute otitis media typically follows viral upper respiratory tract infections, which disturb the nasopharyngeal microbiome. This enables bacteria like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis to infect the middle ear via the Eustachian tube.
What are the clinical features of Acute Otitis Media?
Features include otalgia, ear tugging or rubbing by some children, fever in about 50% of cases, hearing loss, and possible ear discharge if the tympanic membrane perforates. Recent viral URTI symptoms are common.
What criteria are commonly used to diagnose Acute Otitis Media?
Diagnosis criteria include acute onset of symptoms, otalgia or ear tugging, presence of a middle ear effusion, bulging of the tympanic membrane, otorrhoea, decreased mobility on pneumatic otoscopy, and inflammation of the tympanic membrane.
How is Acute Otitis Media managed?
Acute otitis media is generally self-limiting and may not require antibiotics unless symptoms persist, the child is systemically unwell, immunocompromised, or at high risk of complications, or under 2 years old with bilateral conditions. Amoxicillin or, in case of allergy, erythromycin or clarithromycin is prescribed.
What are the common sequelae and complications of Acute Otitis Media?
Common sequelae include tympanic membrane perforation leading to otorrhoea and potentially chronic suppurative otitis media if unresolved over 6 weeks. Complications can include mastoiditis, meningitis, brain abscess, and facial nerve paralysis.
An 18-month-old girl is brought to her general practitioner with a three-day history of poor feeding and pulling at their ears. Her observations are as follows:
Respiratory rate of 26 breaths/min
Pulse of 123 beats/min
Temperature of 37.1ºC
Blood pressure of 94/58mmHg
Oxygen saturations of 97%
On examination, you note bulging tympanic membranes with surrounding erythema bilaterally.
What is the appropriate first-line management in this patient?
A delayed prescription of flucloxacillin
Conservative management, ensuring adequate hydration
Immediate prescription of amoxicillin
Immediate prescription of flucloxacillin
Referral to the paediatric assessment unit
Immediate prescription of amoxicillin
If antibiotics are required for otitis media, amoxicillin is first-line
Important for meLess important
The correct answer is an immediate prescription of amoxicillin.
This patient likely has acute bilateral otitis media, as they are younger than two-years-old NICE recommends antibiotic management, the first line being amoxicillin. In patients with penicillin allergy clarithromycin or erythromycin may be used.
A delayed prescription of flucloxacillin is incorrect. Flucloxacillin is useful against B-lactamase producing bacteria. It has good activity against a spectrum of gram-positive and gram-negative bacteria. Flucloxacillin is commonly used to treat impetigo, cellulitis, osteomyelitis, otitis externa, diabetic foot infections and infected leg ulcers.
Conservative management, ensuring adequate hydration is incorrect as this patient meets the NICE criteria for antibiotic prescribing.
Immediate prescription of flucloxacillin is incorrect as this is not the antibiotic of choice in this situation.
Referral to the paediatric assessment unit is incorrect as this patient’s presentation is not suspicious of serious underlying infection and their observations are all within the normal range for her age.
