Otitis Media

Question 1

Otitis media is an infection of which part of the ear?

1 - outer ear
2 - inner ear
3 - cochlea
4 - middle ear

Answer 1

4 - middle ear

Connects the middle ear with the eustachian tube which allowed air to ventilate middle ear and normalises pressure to atmospheric conditions

Question 2

3 of the following bones are contained within the middle ear. Which one of the following is NOT contained within the middle ear?

1 - malleus
2 - sesamoid
3 - incus
4 - stapes

Answer 2

2 - sesamoid
- helps ligaments move over bones and reduce friction

Stapes is the smallest bone.

Outer to inner order is malleus - incus - stapes (MIS)

Question 3

Which bone does the middle bone lie within?

1 - temporal bone
2 - occipital bone
3 - sphenoid bone
4 - nasal bone

Answer 3

1 - temporal bone

Contains mastoid air cells

Question 4

What is the incidence of otitis media?

1 - 25 cases per 100,000
2 - 250 cases per 100,000
3 - 2500 cases per 100,000
4 - 25,000 cases per 100,000

Answer 4

2 - 250 cases per 100,000

Affects boy and girls equally

Question 5

Otitis media can affect any age, but which age is this most common in?

1 - <12 months
2 - <4 y/o
3 - <8 y/o
4 - <16 y/o

Answer 5

2 - <4 y/o

Question 6

Which of the following is NOT an intrinsic risk factor for otitis media?

1 - gender
2 - atopic predisposition
3 - immunosuppression
4 - conditions affecting ciliary motility

Answer 6

1 - gender
- affects boys and girls equally

Conditions affecting ciliary motility include:
- Cystic fibrosis
- Primary ciliary dyskinesia
- Kartagener’s syndrome (autosomal recessive genetic ciliary disorder comprising of the triad of situs inversus, chronic sinusitis, and bronchiectasis.

Question 7

Which of the following is NOT an extrinsic risk factor for otitis media?

1 - Passive smoking
2 - No pneumococcal vaccination
3 - Daycare
4 - Breast fed Bottle feeding
5 - Use of a dummy (pacifier)
6 - Low socioeconomic status

Answer 7

4 - Breast fed

Typically increased risk with bottle feeding as the strong swallow required to feed from a breast induces a sizeable negative pressure in the infants oral cavity allowing eustachian tube insufflation.

Question 8

Otitis media typically occurs due to which of the following?

1 - wide eustachian tube leading to ascending infection
2 - narrowing of outer ear causing infection of tympanic membrane that spreads to inner ear
3 - oedema and narrowing of eustachian tube, stops ear from draining
4 - all of the above

Answer 8

3 - oedema and narrowing of eustachian tube, stops ear from draining

Lack of drainage predisposes inner ear to colonisation of bacteria.

The earache patients typically have is because the blocked eustachian tube does not allow equalisation of pressure in the ear, which could lead to rupture of the tympanic membrane to try and equalise the pressure

Question 9

All of the following can occur in otitis media, but which is most common?

1 - viral only cause
2 - bacterial only cause
3 - bacteria + viral cause
4 - fungal and viral

Answer 9

1 - viral only cause

All others can also occur

Question 9

Children are more likely to develop otitis media for all of the following reasons, EXCEPT which one?

1 - narrower eustachian tubes
2 - increased fluid in eustachian tubes that can lead to infections
3 - eustachian tubes are more horizontal, inhibiting drainage
4 - more prone to respiratory infections

Answer 9

2 - increased fluid in eustachian tubes that can lead to infections

In ear examinations, the horizontal position of the eustachian tubes in children is why we pull the pinna down for paediatric examination, and up for adults

Question 10

Biofilms can occur in children with otitis media. Are treatments more of less effective in patients with biofilms in otitis media?

Answer 10

• less effective

Antibiotics have poor penetration of the biofilms

Question 11

3 of the following bacteria account for 95% of bacterial cultured from patients with otitis media. Which one is NOT one of these 3?

1 - Streptococcus pneumoniae
2 - Staphylococcus aureus
3 - Moraxella catarrhalis
4 - Haemophilus influenzae

Answer 11

2 - Staphylococcus aureus

Question 12

All of the following viruses can cause otitis media, but which is the most common?

1 - Respiratory syncytial virus
2 - Coronavirus
3 - Adenovirus
4 - Rhinovirus
5 - Influenza (all types)
6 - Enterovirus
7 Parainfluenza (all types)

Answer 12

1 - Respiratory syncytial virus

Accounts for 41-56% of cases

Question 12

What is the cut off for acute otitis media?

1 - <72h
2 - <1 week
3 - <3 weeks
4 - <3 months

Answer 12

3 - <3 weeks

> 3 months to be chronic otitis media

Question 13

Acute otitis media can progress to acute otitis media with effusion. What is this?

1 - otitis media with bacteria infection of middle ear
2 - otitis media with viral infection of middle ear
3 - otitis media with collection of fluid in middle ear
4 - can be any of the above

Answer 13

3 - otitis media with collection of fluid in middle ear

Most common cause of hearing impairment in childhood owing to its high incidence.

Acute otitis media can progress to chronic (>3months) otitis media with effusion also known as glue ear, less common than acute though

Question 14

Chronic suppurative otitis media (CSOM) is defined as chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges (otorrhoea) through a tympanic perforation. How long must this typically last for to reach this diagnosis?

1 - >2 days
2 - >2 weeks
3 - >2 months
4 - >2 years

Answer 14

2 - >2 weeks

Question 15

Otitis media can have a

All of the following are typical signs that can present in patients with variations of otitis media, EXCEPT which one?

1 - otalgia (ear pain)
2 - tugging or rubbing of the ear
3 - fever occurs in all patients
4 - viral URTI symptoms are common (e.g. coryza)
5 - ear discharge may occur if the tympanic membrane perforates
6 - hearing loss

Answer 15

3 - fever occurs in all patients

Fever can occur, but only in around 50% of cases

Question 16

Which of the following may be visible on otoscopy in a patient with otitis media?

1 - bulging tympanic membrane (loss of light reflex)
2 - opacification or erythema of the tympanic membrane
3 - perforation with purulent otorrhoea (discharge, can be red/ywllow)
4 - decreased mobility if using a pneumatic otoscope
5 - all of the above

Answer 16

5 - all of the above

Question 17

Which of the following is the most useful diagnostic tool to diagnose a patient with otitis media?

1 - clinical diagnosis
2 - vital signs
3 - head X-ray
4 - biochemistry and blood cultures

Answer 17

1 - clinical diagnosis

Examination and history taking

Question 18

All of the following can be complications of otitis media, except which one?

1 - Mastoiditis
2 - Papilledema
3 - Meningitis
4 - Intracranial abscesses
5 - tympanic membrane rupture

Answer 18

2 - Papilledema

Question 19

Which of the following should be considered as likely diagnoses in otitis media?

1 - impacted cerumen
2 - Otitis externa
3 - Foreign body
4 - Cholesteatoma
5 - Bullous myringitis
6 - Mastoiditis
7 - Labyrinthitis
8 - all of the above

Answer 19

8 - all of the above

Question 20

Does otitis media always require the use of antibioitcs?

Answer 20

• no

The majority of cases will resolve without treatment

Question 21

Antibiotics are not always required in otitis media (OM), except in all of the following groups, EXCEPT which one?

1 - Children <2 y/o with bilateral OM
2 - Children <3 months with a temperature >38ºC
3 - Children <5 y/o with previous OM
4 - OM with ear discharge
5 - Systemically unwell patient with OM that persists with positive ear swab
6 - patients at high risk of complication

Answer 21

3 - Children <5 y/o with previous OM

Question 22

Which 2 of the following are typically 1st line treatment for otitis media?

1 - Amoxicillin (5-7 day course)
2 - Erythromycin or clarithromycin
3 - Gentamycin
4 - all of the above

Answer 22

1 - Amoxicillin (5-7 day course)
2 - Erythromycin or clarithromycin

Question 23

Which of the following should be performed if antibiotics do not treat otitis media?

1 - referral to ENT
2 - consider alternative diagnosis
3 - add co-amoxiclav to current antibiotic
4 - all of the above

Answer 23

3 - add co-amoxiclav to current antibiotic

Question 24

Which of the following is NOT a common complications for otitis media (OM)?

1 - Chronic OM
2 - Hearing loss
3 - Tympanic membrane perforation
4 - Tinnitus
5 - Mastoiditis

Answer 24

5 - Mastoiditis

Can happen, but not a common complication

Question 25

Which of the following is NOT an uncommon complications for otitis media (OM)?

1 - Mastoiditis
2 - Bacterial meningitis
3 - Tinnitus
4 - Extradural abscess
5 - Subdural abscess
6 - Labyrinthitis
7 - Facial paralysis

Answer 25

3 - Tinnitus

This is a common complication of OM