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AUDE 5410 Aud-Vestib Disorders > Middle Ear Disorders - OME > Flashcards

Middle Ear Disorders - OME Flashcards

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1
Q

what is otitis media (w/ effusion)

A

infectious inflammation of the ME that results in accumulation of fluid (effusion) in ME cavity

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2
Q

why is acute myringitis often misdiagnosed as acute OM

A

redness of TM without effusion

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3
Q

what can cause rednss of tm without underlying effusion/infection that can be mistaken for OM

A

Excessive blowing of the nose/crying especially in younger children,

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4
Q

what is the historical disorder reported in egyption mummies

A

TM perforations and mastoid bone destruction
OME

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5
Q

what type of tymp could you see in OME

A

most likely will see type b with fluid in there
type c tymp - could be if it is in the beginning process (neg pressure)

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6
Q

as the child grows older the number tht has OME goes_____

A

down

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7
Q

the younger the child the more they _____ OME

A

have

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8
Q

second only to viral infections of upper respiratory tract as the most common reason for visits to the pediatrician

A

OME in children

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9
Q

An epidemiologic study by the University of Pittsburgh revealed an incidence of ______for OM for children in urban areas within the first 2 years of life

A

90%

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10
Q

what age group do we see more OME

A

1 yr to before school age

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11
Q

with a child who has a risk of upper respiratory infection why does it risk OME?

A

because ET is opened to the nasopharynx and is surrounded by soft muscles and with inflammation of upper respiratory, these muscles swell and it closes off opening of ET, hard for it to drain
connection to the back of throat to the middle ear

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12
Q

what race is more common OM and the less common

A

caucasians, asians and blacks

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13
Q

higher incidence of OM in ___ than ____

A

males, females

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14
Q

what is peak incidence of OME

A

October and April; incidence declines during the summer months

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15
Q

Greater incidence in children with a history of upper respiratory illness such as

A

colds, asthma, and allergies

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16
Q

children outgrow susceptibility to OM by ______ years of age as the ET assumes adult proportions

A

6-8

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17
Q

Three factors facilitate bacterial reflux in the ME

A

Incompetence of the protective function of the ET
Negative pressure in the ME in relation to the nasopharynx
Bacterial colonization of the nasopharynx

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18
Q

what are the etiologies of OM

A

bacterial and viral

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19
Q

what are bacterial etiologies of OM

A

most commonly found in upper respiratory tract infections
Streptococcus pneumoniae
Hemophilus influenzae

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20
Q

what are viral etiologies of OM

A

Respiratory syncytial virus – most common (RSV
Rhinovirus
Parainfluenza virus
Influenza virus

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21
Q

what are the 3 criteria set by amerian academy of pediatrics and american academy of family physicians for acute otitis media diagnosis

A

acute onset
ME inflammation
ME effusion (ME fluid buildup

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22
Q

what is acute otitis media (AOM)

A

Short-term (< 3 weeks), a self-limiting condition

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23
Q

what ar ethe two types of AOM

A

severe & non severe

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24
Q

describe severe AOM

A

Moderate to severe otalgia and temperature > 1020F (39°C)

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25
describe non severe AOM
Mild otalgia and temperature < 1020F (39°C)
26
what is often over diagnosed
AOM
27
what are the 3 stages of AOM
hyperemic stage aom with effusion aom with supperative stage
28
what are the classifictions of om basaed on duration
sub acute recurrnt chronic
29
what is sub acute om
condition persisting for 3 weeks to 3 months
30
what is recurrent om
Multiple self-limiting episodes with symptom-free periods between flare-ups 3 or more episodes w/in 6 mo period OR 4 or more episodes
31
what is chronic om
Condition persisting for > 3 months (> 30 days-Text) Generally with effusion but without other signs of inflammation i.e., fever or otalgia
32
what is me effusion
almost always follows AOM and can take 2 to 3 weeks to clear post treatment/recovery
33
describe persistent mee
Effusion can persist for an average of 40 days High incidence of persistent MEE in children children <2 yrs are more likely to have persistent MEE Higher incidence of persistent MEE for Caucasian children
34
Serous effusion can occur without OM such as in cases of
barotrauma
35
what is barotrauma
a lot of divers sudden change of pressure seasonal allergies airplane trips
36
hwen do you recommend they come back and follow up and give antibiotics for 7 days?
2-3weeks to make sure the fluid has been absorbed
37
om classification based on fluid
Serous OM (SOM - clear) Mucoid OM (MOM - thick and colored) Purulent OM (POM - odorous and thick) “Glue ear”
38
Serous OM (SOM -
clear fluid, not infected
39
why are infants being breast fed less likely to be affected?
antibodies that go through placenta and when theyy are born, breast feeding, immunogobulins are delivered to baby through the breast milk immune system is building in first 3 months of life
40
Mucoid OM (MOM
pussy, coloredv= infection because it is pussy (yellow, green, etc.) thick and colored
41
Purulent OM (POM
odorous and thick
42
what is glue ear
used to describe chronic mucoiud OM If chronic low grade ME infection persists due to chronic ET dysfunction it will lead to the ME cavity filling with gelatinous inflammatory exudate/cellular debris - the “glue” of glue ear This process may lead to retraction of the TM and ultimately formation of retraction pockets and bone erosion self limiting in most cases
43
what are risk factors for OME
age (peak bw 6-11 mos) ET dysfunction craniogacial anomalies (increased with cleft lip/palate and down's) decreased risk for breast fed day care attendance usceptibility to upper respiratory tract infections (URTI)/allergies Smoking in the home including second-hand smoke Family history of OME Male Low birth weight (< 1500 grams or 3.3 lbs) Socio-economic status (SES): Inverse relationship between SES and OME probably because of lack of access to health care, poor diet and overcrowding
44
what are symptoms of OME
Otalgia Fever otalgia & fever an be absent in older children Erythema (redness) of the TM Effusion in the ME Irritability/fussiness May not want to eat Inconsistent responses to sound Delayed speech and language development Reduced attention span especially in the classroom
45
what could OME otososcopy look like
Discolored/red TM Opacification of normally lustrous TM Partial/complete bulging of TM with obliteration of malleolar handle Retracted TM Perforation of TM Fluid line or bubbles observe in the middle ear
46
what is opacification
blurring/spreading of the cone of light
47
what could you see for immitance results on OM
Flat (Type B) tympanogram Negative pressure >200 daPa (Type C) tympanogram Flat high volume (Type B - high volume) tympanogram consistent with TM perforation Inability to get a hermetic seal (with perforation) in older equipment Abnormal (elevated)/absent ARTs
48
what would you see for unilateral OM in ARTs
Typical only the ipsilateral ART will be present on the unaffected side
49
for bilateral OM what would you see in ARTs
Ipsilateral and contralateral ARTs will be abnormal for both ears
50
children ECV
around 1 to 1.2 ml
51
what pure tone results could you see
w/in normal limits (
52
if you have a r om, what would l art look like
left ipsi would only be noral contra would need to be elevated/abs in order for it to cros over to the unaffected side
53
what speech audiometry results would we expect with OM
normal supras (WRS) sr-pta are in good agreement
54
what is a rising configuration?
abnormal lf and rising to normal or close to normal hf hearing
55
what is a sloping configuration?
normal to near normal lf and hf abnormal hearing
56
normal to near normal lf and hf abnormal hearing
middle ear
57
what would you expect speech to be with CHL with om
srt and pta will be in agreement (both are threshold tests)
58
what is a max chl
if loss goes below this level, bone shifts as well (some involvement of a cochlear loss) around 60-65dB after this it starts to effect bone and shifts to a mixed loss
59
what is the most common configuration for chl
rising abg low frequency loss around 2-3000 becomes normal
60
do all chl look the same
many different patterns for middle ear pathology and om depending on severity of the condition have to be aware of what to expect many ways it can present itself
61
critical learnig language period
0-3
62
what are the consequences of OM
permanent/temporary chl damage to me structures cholesteatoma permanent hf snhl
63
how can we get permanent hf snhl with om
Inner ear structures affected by passive diffusion or active transportation of toxins through round window membrane resulting in a permanent SNHL
64
what damage to middle ear structures do we see with om
can lead to ossicular destruction and conductive hearing loss, common with “glue ear” Release of inflammatory mediators in ME space and release of specific enzymes, such as collagenase, a tissue destructive protease, that can lead to ossicular destruction and conductive hearing loss, common with “glue ear
65
why do we see cholesteatoma in om
66
what higher order auditory fxn do we see ome
auditory deprivation that can affect language development binaural auditory processing deficits difficulty discriminating speech sounds (ta vs da) issues w/ initial and final voiced/voiceless plosives (b vs p) issues attending to auditory input (learned inattentioin)
67
OME consequences
Higher order auditory function Known long-term implications Structural changes
68
long term implications of ome
attention deficit through adulthood s/l delays (esl who have ome are at greater risk) academic failure behavioral issues risk factor for CAPD
69
structural changes due to ome
altered abr recordings after ome resolution during pre adolescent years alteration of acoustic-immittance characteristics of me system - larger tymp widthy, shallow admittance, elevated arts
70
thickened mucous that adheres to the ossicles and adheres them to the mastoid
glue ear
71
what is the pseudotumor
not a real tumor, but it acts like a tumor grows rapidly and very invasive
72
w/ chronic/untreated OME or chronic - ve ME pressure
cholesteatoma
73
most common reason for visit to pediatricians
om
74
what are some societal consequences of om
annual expenditure is around $3.5 billion most common pedistrician visit time off work, & school (lossof productivity) tymp tube placement is 2nd most common surgical procedure in children development of multidrug resistant bacteria
75
2nd most common surgical procedure in children
Tympanostomy tube placement
76
what are sytpms of chronic ome
Can be asymptomatic May have a hearing loss May report feeling “plugged” May report “popping” of ears
77
what are symptoms of acute om
Can follow upper respiratory tract infection Fever Otalgia Hearing loss (temporary) Otorrhea May have associated systemic symptoms Nausea General malaise Lack of appetite
78
what is the gold standard for diagnosing ome
pneumatic otoscopy
79
Standard otoscopy may be useful in visualizing
TM color Opaque, yellowish red, red or pink Position Bulging or retracted TM (-ve pressure tympanogram) Mobility Normal, hypo-mobile, or retracted TM Other findings Discharge, perforations, cholesteatoma, or retraction pockets
80
audiologic diagnosis of OME
chl mixed hl snhl flat type b (can have high volume) type c neg pressure abnormal gradient/width abn/abs reflexes
81
what medictions are needed for OME (AOM)
antihistamine/decongestants antibiotics myringotomy
82
Resolution of condition occurs in 7 to 14 days for ____ of untreated children and _____ of treated children
81% 94%
83
____ can typically persist for > 2-3 weeks following antibiotic therapy and after resolution of the actual infection
Effusion
84
why are Prophylactic/prolonged antibiotics are contraindicated
because of an increase in antibiotic resistance
85
what is prophylcactic
prevention
86
why would management include Adenoidectomy and/or tonsillectomy
it decreases the need for repeated PE tube replacement
87
what are some compications from OM
acute mastoiditis ossicular erosion (CHL) SNHL (toxins going through round window) facial n paralysis labyrinthine fistula meningitis brain abscess

AUDE 5410 Aud-Vestib Disorders (18 decks)

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