B3-054 - AOM and OME

Question 1

______ is the most common reason for Antibiotic prescriptions in children

Answer 1

Otitis Media

Question 2

Rates of otitis media are _____

Answer 2

Declining

Question 3

Why are fewer people visiting the doctors office for OM?

Answer 3

• increased cost of copayments
• increased public education
• use of conjugated pneumococcal vaccine
• increased flu vaccine
• better differentiation between AOM and OME

Question 4

AOM

Answer 4

Acute Otitis Media

Question 5

OME

Answer 5

Otitis Media with Effusion

Question 6

Path of AOM

Answer 6

usually occurs with or following viral upper respirator tract infection (URI)

Question 7

75% of URI have______

Answer 7

Eustachian tube dysfunction

Question 8

Breakdown of bacteria/viral distribution of AOM cases

Answer 8

66% - bacterial and viral
27% - bacterial only
4% - viral only

Question 9

Bacterial culprits of AOM

Answer 9

• Strep. pneumonia
• nontypal Haemaphilus influenza (nTHi)
• Moraxella catarrhalis
• Strep. pyogenes (school age children)

Question 10

Age distribution of 1st episode of AOM

Answer 10

• 16% 0-6m
• 44% 7-18m
• 40% 19m-2yr

Question 11

___% of children with OM had more than 4 episodes of AOM

Answer 11

40%

Question 12

Risk factors for AOM

Answer 12

• day care
• non-hispanic white
• atopy
• siblings
• family history

Question 13

Symptoms of AOM

Answer 13

• rapid onset ear pain (50-60% of cases)
• young children: tugging at ears, fever, excessive crying, changes in sleep
  Best: “cloudy”, bulging TM with impaired mobility

Question 14

Bulging TM is highly _____, whereas impaired TM mobility is highly _____.

Answer 14

specific; sensitive.

Question 15

OME path

Answer 15

Often aftermath of AOM or consequence of Eustachian tube dysfunction from URI
Can precede AOM

Question 16

OME and antibiotics

Answer 16

Should AVOID

Question 17

AOM diagnosis

Answer 17

Moderate to severe bulging TM or new onset ear liquid not from AOE

OR

Mild bulging of TM and recent (within 48 hr) ear pain of intense erythema of the TM

Question 18

AOM diagnosis must have ______

Answer 18

Middle ear effusion (MEE)

Question 19

When is observation treatment an option?

Answer 19

• 6m-2yr non severe, unilateral
• 2+ year, non severe, unilateral
• 2+ year, non severe, bilateral

Question 20

Drug of choice for AOM

Answer 20

Amoxicillin 80-90mg/kg/day divided bid. Reassess within 48-72 hrs

Question 21

OME

Answer 21

Fluid in ear, without pain or bulging of TM

Question 22

Most cases of OME resolve within ___

Answer 22

3 months

Question 23

____% of children have repeat OME

Answer 23

30-40%

Question 24

___% of OME episodes last more than 1 year

Answer 24

5-10%

Question 25

___% of OME last more than 3 months

Answer 25

25%

Question 26

"Watchful Waiting" protocol

Answer 26

- no ABx, anti-hist, decongestants, or steroids - After 3m, get a hearing test

Question 27

Who is at risk for OME

Answer 27

- CMV, downs syndrome, cleft palate, blind

Question 28

Rough Surgery Guidelines for Tubes

Answer 28

- Less than 4yr: tubes - 4+ yrs: tubes and/or adenoidectomy

Question 29

AOM - First Line Treatment for Initial Antibiotic Therapy

Answer 29

Amoxicillin (80-90 mg/kg/day in 2 divided doses) or Add clavulanate if pt received amoxicillin within previous 30 days

Question 30

AOM - First Line Alternative treatment if allergic to PCNs

Answer 30

Cefdiner, Cefuroxime, Cefpodoxime, Ceftriaxone (50mg/kg IM or IV for 3 days)

Question 31

AOM - ABx treatment after 48-72hrs of Failure of Initial Therapy

Answer 31

Add Clavulanate to amoxicillin if not already being used or Ceftriaxone (50mg/kg IM or IV for 3 days)

Question 32

AOM - Alternative ABx treatment after 48-72hrs of Failure of Initial Therapy

Answer 32

Ceftriaxone 3 days or clindamycin with or without third-get cephalosporin or Clindamycin plus third-get cephalosporin. Tympanocentesis