B3-054 Otitis Media

Question 1

AOM usually occurs with or following

Answer 1

a viral URTI

**eustachian tube dysfunction occurs in 75% of children with viral UTRI

Question 2

Four bacterial pathogens consistent with AOM

Answer 2

S. pneumoniae
NTHi
M. catarrhalis
S. pyogenes

Question 3

NTHi otitis media is often seen with

Answer 3

conjunctivitis

Question 4

risk factors for AOM

Answer 4

daycare attendance
non-hispanic white
atopy
having siblings
family hx of recurrent AOM

Question 5

breastfeeding is

Answer 5

protective for AOM

Question 6

AOM usually presents with

Answer 6

rapid onset of pain

Question 7

in preverbial children, otalgia is suggested by

Answer 7

tugging, rubbing, holding ears
excessive crying
changes in sleep/behavior

Question 8

which symptom of AOM is most useful in diagnosis?

Answer 8

ear pain

Question 9

what is the best predictor of AOM using symptom-based diagnosis?

Answer 9

cloudy, bulging TM with impaired mobility

Question 10

Impaired mobility has [specificity/sensitivity]

Answer 10

high specificity, high sensitivity

Question 11

TM bulging has [sensitivity/ specificity]

Answer 11

high specificity; low sensitivity

Question 12

OME may occur

Answer 12

after AOM
due to eustachian tube dysfunction

Question 13

OME and AOM are segments of

Answer 13

disease continuum

Question 14

OME may precede

Answer 14

AOM

Question 15

does OME indicate infection?

Answer 15

no

Question 16

does OME indicate infection?

Answer 16

no

Question 16

does OME indicate infection?

Answer 16

no

Question 17

does OME require antibiotics?

Answer 17

no

Question 18

moderate-severe bulging of TM
OR
new onset otorrhea

Answer 18

AOM

Question 19

mild-bulging of TM and recent onset of ear pain
OR
intense erythema of the TM

Answer 19

AOM

Question 20

clinicians should not diagnose AOM in children who do not have

Answer 20

MEE on otoscopty or tympanometry

Question 21

bulging of TM or limited/absent motility
Air-fluid level behind TM
otorrhea

Answer 21

MEE

Question 22

AOM treatment should include a plan for

Answer 22

pain

Question 23

treatment option for uncomplicated AOM

Answer 23

observation

**based on illness, age, severity, and availability to follow up

Question 24

severe illness in AOM is considered

Answer 24

moderate to severe otalgia fever >39

Question 25

if observation is chosen as the treatment method, what must be in place?

Answer 25

mechanism for followup and plan to start antibiotics if condition worsens in 48-72 hours

Question 26

observation is an option under two years of age if

Answer 26

AOM is unilateral and not severe

Question 27

If the child is more than two years old, is observation an option for bilateral AOM?

Answer 27

yes

Question 28

Antimicrobial therapy is always recommended in AOM with

Answer 28

otorrhea

Question 29

initial antimicrobial treatment for AOM

Answer 29

amoxicillin

Question 30

when should you prescribe additional beta-lactamase coverage for AOM?

Answer 30

if the child has received amoxicillin in the past 30 days OR has a history of recurrent AOM unresponsive to amoxicillin

Question 31

when might you use ceftriaxone to treat AOM?

Answer 31

48-72 hours after failure of initial treatment OR as an alternative treatment for penicillin allergy

Question 32

presence of fluid in the middle ear without symptoms of acute infection

Answer 32

OME

Question 33

____% of children have OME before school age

Answer 33

90 ***greater than 50% will experience in first year of life

Question 34

most episodes of OME resolve spontaneously within

Answer 34

3 months

Question 35

persistant OME causes

Answer 35

decreased mobility of TM

Question 36

OME can cause

Answer 36

conductive hearing loss

Question 37

OME is the most common cause of ________ in children in developed countries

Answer 37

hearing loss

Question 38

pneumatic otoscopy should be performed in a child with

Answer 38

otalgia, hearing loss, or both

Question 39

clinicians should document MEE with ________ when diagnosing OME

Answer 39

pneumatic otoscopy

Question 40

tympanometry should be performed when

Answer 40

diagnosis is uncertain after otoscopy

Question 41

watchful waiting

Answer 41

managing a child with OME not at risk for 3 months from the date of effusion onset/diagnosis

Question 42

no antibiotics no antihistamines/decongestants no intranasal or systemic steroids

Answer 42

watchful waiting

Question 43

when should clinician perform a hearing test?

Answer 43

if OME persists longer than 3 months OR OME of any duration in at risk child

Question 44

risk factors for hearing loss with OME

Answer 44

autism, down syndrome, cleft palate, developmental delays

Question 45

healthy children with persistent OME who do not have at risk criteria can be observed for

Answer 45

6-12 months

Question 46

clinicians should reevaluate OME at _________ intervals until it resolves or a cause if found

Answer 46

3-6 months

Question 47

what is recommended when surgery is performed for OME <4 years?

Answer 47

tympanostomy tubes

Question 48

what is recommended when surgery is performed for OME >4 years?

Answer 48

tympanostomy tubes and/or adenoidectomy