Gremlin: Acute Otitis Media

Question 1

risk factors for AOM

Answer 1

• genetic predisposition/family hx
• allergies
• only bottle fed
• low socioeconomic status
• smoke exposure
• daycare
• pacifier use
• winter

Question 2

s/s of AOM

Answer 2

• AOM specific
  - otorrhea (drainage)
  - otalgia (pain)
  - bulging typanic memrane
• nonspecific
  - HA
  - poor sleep
  - poor feeding
  - vomit/diarrhea
  - fever

Question 3

Uncomplciated AOM

Answer 3

No otorrhea

Question 4

non severe AOM

Answer 4

mild otalgia AND temp < 39 C

Question 5

severe AOM

Answer 5

mod-severe otalgaia OR temp > 39C

Question 6

recurrent AOM

Answer 6

• 3 separate occasions of AOM in past 6 months
• 4 seperate occasions of AOM in past year with one of them in the past 6 months

Question 7

who qualifies for observation (instead of treatment in AOM) and why

Answer 7

infection likely to self-resolve
- pts > 2 years with mild symptoms
- pts 6 months - 2 years with unilateral AOM without otorrhea

iniatae ABX in 48-72 hrs if s/s worsen or persist

Question 8

AOM ABX treatment

Answer 8

amoxiciillin or augmentin 90 mg/kg/day divided BID
- in pts < 2 yrs: 10 day duration
- pts > 2 years: 5-7 days

Question 9

If a pt has a penicillin allergy, how do you treat their AOM

Answer 9

• Cefdninr 14mg/kg/day in oance daily or twice daily dosing
• Cefuroxime 30mg/kg/day divided BID
• Cefpodoxime 10mg/kg/day divided BID
• Ceftriaxone 50mg IM or IV QD 1-5D

Question 10

treatment of pain

Answer 10

• APAP 10-15mg/kg/dose Q4-6H PRN
• Ibuprofen (only if > 6 months): 5-10mg/kg/dose Q6H PRN

Question 11

Tympanostomy tubes

Answer 11

• surgiclaly placed for pts with recurrent AOM
  
  • Moves fluid form behind ear drum to outside ear
  • Disadvantage: can scar typmanic membrane