AOM Flashcards
(17 cards)
Otitis media is the name given to an infection in the [] ear
The [] ear is the space that sits between the [] (ear drum) and the [] ear.
Otitis media is the name given to an infection in the middle ear
The middle ear is the space that sits between the tympanic membrane (ear drum) and the inner ear.
What are the components to thei inner ear? [3]
This is where the cochlea, vestibular apparatus and nerves are found. It is a very common site of infection in children
Describe the very basic pathophysiology of OM [1]
The bacteria enter from the back of the throat through the eustachian tube. A bacterial infection of the middle ear is often preceded by a viral upper respiratory tract infection.
The most common bacterial causes of otitis media, as well as other ENT infections such as rhino-sinusitis and tonsillitis is []
The most common bacterial causes of otitis media, as well as other ENT infections such as rhino-sinusitis and tonsillitis is streptococcus pneumoniae.
Other common causes include:
* Haemophilus influenzae
* Moraxella catarrhalis
* Staphylococcus aureus
Describe the presentation of AOM
Otitis media typically presents with ear pain, reduced hearing in the affected ear and general symptoms of upper airway infection such as fever, cough, coryzal symptoms, sore throat and feeling generally unwell.
95% of bacteria isolated from infected middle ears are which following three pathogens? [3]
Streptococcus pneumoniae
Moraxella catarrhalis
Haemophilus influenzae
The most commonly isolated viruses in AOM is? [1]
Describe the classifications of OM (acute vs chronic)
Acute
* Acute otitis media
* Acute otitis media with effusion (may progress to chronic OM with effusion or chronic suppurative)
Chronic OM with effusion
* Characterised by a build up of fluid behind an intact TM.
* Must be present for >3 months to support diagnosis.
* Also known as glue ear.
Chronic suppurative
* Discharge present for >2 weeks can support a diagnosis, however some specialists will only diagnose after 6 weeks.
* Presents with persistent ear discharge through a perforated tympanic membrane (TM).
Features of OM? [+]
otalgia
+ some children may tug or rub their ear
* fever occurs in around 50% of cases
* hearing loss
* recent viral URTI symptoms are common (e.g. coryza)
* ear discharge may occur if the tympanic membrane perforates
Describe what otoscopy findings would indicate OM? [5]
- bulging tympanic membrane → loss of light reflex
- opacification or erythema of the tympanic membrane
- perforation with purulent otorrhoea
- decreased mobility if using a pneumatic otoscope
Pulsenotes:
* Red, yellow or cloudy tympanic membrane
* Bulging tympanic membrane or perforated membrane
* Air-fluid level behind the tympanic membrane
NB: In a normal child the tympanic membrane should be “pearly-grey”, translucent and slightly shiny. You should be able to visualise the malleus through the membrane and a cone of light reflecting the light of the otoscope.
Otitis media will give a bulging, red, inflamed looking membrane. When there is a perforation, you may see discharge in the ear canal and a hole in the tympanic membrane.
Describe the managment plan for OM [+]
Explain the condition to the patient and their family, as well as the fact that it is generally self-limiting
- Normally the illness lasts 3 days but it may last up to a week.
Always refer for specialist assessment and to consider admission in infants younger than 3 months with a temperature above 38ºC or 3 – 6 months with a temperature higher than 39ºC.
For most patients OM has conservative management.
When would you prescribe ABx? [6]
In the following groups it is recommended to prescribe antibiotics
* Children under the age of two with bilateral OM
* Children younger than 3 months with a temperature over 38ºC
* OM with ear discharge
* Those who are systemically unwell
* Those at high risk of complication
A prescription for antibiotics may be given with the advice to take in 3 days if symptoms do not being to improve, or the patient becomes systemically unwell.
Abx for AOM? [2]
First line antibiotics
Amoxicillin (5-7 day course)
Erythromycin or clarithromycin
How do you manage acute and chronic otitis media with effusion (glue ear)? [+]
In primary care, management is started conservatively, with observation for a period of 6-12 weeks, as the condition often spontaneously resolves.
Pure tone audiometry should be performed in this time.
A referral to secondary care should be made if:
- there is concern with the child’s development:
- The hearing loss persists after other symptoms have resolved
- There is severe hearing loss
- The child has Down’s syndrome or cleft palate
Describe the secondary care management for Acute and chronic otitis media with effusion (glue ear) [3]
Hearing aids
* Often offered to patients with persistent bilateral symptoms
Eustachian tube autoinflation
* This involves blowing up a balloon with the nostrils several times a day
Surgical; myringotomy with grommet insertion
* A grommet is a tube, surgically inserted in the TM, that allows middle ear ventilation and the drainage of excess secretions. They are ordinarily a temporary measure lasting around 12 months.
Describe the common complications of OM [4]
Chronic OM
* In 8% of children, acute OM will progress to chronic OM.
Tympanic membrane perforation
* This is a common occurrence and will ordinarily heal within a few weeks. Patients should be advised to avoid swimming and to be careful when in the shower. Assessing the site of perforation is important, as perforations in the upper portion of the drum are more likely to lead to mastoiditis and will require closer monitoring.
Hearing loss
* More common with recurrent otitis media
* In most cases, this will resolve with healing of the TM.
Tinnitus
name a serious commplication of OM that requires IV abx [1] Tx? [1]
Mastoiditis is a serious complication of OM requiring IV antibiotics. In some cases surgery is necessary.
- Surgical options include a myringotomy (surgically draining the middle ear) and mastoidectomy (removing affected part of the mastoid bone).
