Flashcards in OM Deck (74):
What is AOM?
Acute inflammatory disease of the middle ear and TM with or without purulent middle ear fluid
What is the definition of OME (OM with effusion)?
Presence of middle-ear effusion without any local or systemic signs of inflammation
What are the physical exam findings of AOM? (3)
-Perforation w/ drainage
What are the symptoms of AOM? (4)
What percent of children are diagnosed with OM by 9 months of age?
What percent of children are diagnosed with OM by 2 years of age?
What is the peak age for recurrence of OM?
6-12 months of age
True or false: The incidence of OM is increasing in the developed world
True or false: the heavy burden of OM is still in the developing world
What are the two ethnicities that have an increased incidence of OM in the US?
Children with an atypical course of OM should be worked up for what?
Immune workup looking for common variance of immunosuppression, such as IgG subclasses deficiency
Why are kids with T21 more susceptible to OM?
Craniofacial abnormality predisposes them
What is the effect of an untreated cleft palate and the incidence of OM?
What is the chromosome that may play a role in predisposition to OM?
What are the environmental risk factors for the development of OM? (3)
What is the role of breastfeeding and the incidence of OM?
Increased risk for 3 or more OM in children who are breastfed less than 6 months
What is the role of pacifiers and the incidence of OM?
True or false: for the most part, kids with OME are asymptomatic
What is the main concern with OME?
Long term consequences of hearing loss
What is the usual precipitating event for OME?
What is the suspected pathophysiology of OME?
Eustachian tube dysfunction
What are the three most common pathogens that cause OM?
1. Strep pneumo
2. H. influenza
3. Moraxella catarrhalis
What is the trend in the causes of OM?
-Increase in H. influ, decrease in Strep
What is the role of antihistamines in the treatment of OM?
Do not use
What is the role of corticosteroids in the treatment of OM?
Do not use
What is the role of decongestant in the treatment of OM?
Do not use
What is the role of allergies in the development of AOM?
Thought to play a role, but unsure
What is the relation between kids with gastroesophageal reflux and AOM?
Positive correlation, with treatment of GERD leading to decreased rates
What GI protein has been identified within the middle ear of pts undergoing placement of myringotomy for OME?
Pepsin and pepsinogen
What is the major preventive strategy against AOM?
What are the vaccines available for AOM?
What, epidemiologically, has changed with the development of the strep pneumo vaccine?
Decreased incidence of AOM, and major decrease in invasive disease
How is the strep pneumo vaccine made to induce a response to the polysaccharide capsule?
Conjugated to the H. influenza protein D
What are T cell independent antigens?
Ones that do not use T cells to produce an immune response
The Hib vaccine is for the polysaccharide capsule. Explain how it is effective.
Conjugated to the diphtheroid toxin
What is happening to the incidence of non typeable influenzae infections?
What is the most common organism that causes extracranial infections 2/2 recent AOM?
What is the usual presentation of infections of moraxella catarrhalis?
Lots of secretions
What is the relationship between the flu and AOM?
Recent flu infection predisposes to AOM
What is the most common etiology of AOM: viral, bacterial, or fungal
What is the current treatment approach to AOM?
Under what age is a contraindication for observation of AOM?
Under 6 months
What are the four major absolute contraindications to just observing AOM?
-Less than 6 months
-Severe illness or previous treatment failure
-Inability to ensure f/u
True or false: previous treatment failure is not a contraindication to observation for AOM
False-- it is an absolute
True or false: an inability to ensure f/u is a contraindication to observing AOM
What are the four relative contraindications for observation with AOM?
-Relapse within the last 30 days
-Bilateral AOM if less than 2 yo
Relapse of AOM within how many days is a relative contraindication to observation with AOM?
True or false: otorrhea is an absolute contraindication to observation for AOM
Bilateral AOM under what age is a relative contraindication to observation?
What is the first line abx for the treatment of AOM? What about if severe?
Normal = Amoxicillin
Severe = augmentin
What is the abx of choice for AOM if there is a PCN allergy?
What is the abx of choice for AOM if there is a PCN and a cephalosporin allergy?
When should kids be reevaluated for an episode of AOM with treatment?
What are the two abx of choice if there is failure to respond to amoxicillin?
-Augment if not already tried
-Ceftriaxone if has tried above
How is ceftriaxone administered?
IM q 3 days
First line therapy for AOM is not an option if recurrence of AOM is within what timeframe?
What is the average course of abx for a short course of AOM? Increased severity?
Average = 5-7 days
Severe = 10 days
When is surgical management (TM tube placement) indicated for recurrent AOM?
Recurrent AOM, with greater than 3 infections in 6 months
4 infections in 12 months
When is TM tube placement indicated for OME? (3)
When effusion present over 4 months
-Significant hearing loss w/ language issue
-Structural changes in the middle ear
True or false: Often there is a dramatic change in kids' behavior following tympanostomy tube placement
What are the signs of chronic, degenerative changes of the middle ear 2/2 recurrent AOM?
What are the two categories of complications with AOM?
-Intratemporal but extracranial
What are cholesteatomas?
A destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Usually 2/2 to untreated chronic OM.
What are the s/sx of a cholesteatoma?
What are the four major intratemporal, but extracranial infections associated with AOM?
-facial nerve palsy
What CN involvement is an indication for an emergency TM tube placement?
What is the classic sign of mastoiditis?
Forward ear protrusion
Picket fence fevers = ?
Sigmoid sinus infections
What are the intracranial problems with untreated AOM?
-Subdural or brain abscesses
-Sigmoid sinus thrombophlebitis
What is otitic hydrocephalus?
Idiopathic hydrocephalus 2/2 AOM
What are the signs that indicate a complicated course of AOM? (5)
-Low intensity pain for more than one week
-Foul smelling otorrhea
-Facial nerve palsy
What type of organisms are associated with mastoiditis with abscesses, and not seen with AOM?
What is the most common organism that causes meningitis 2/2 AOM?