Otitis Media Flashcards
(27 cards)
Define otitis media
Group of inflammation of the middle ear, most common in infants and children
Give the subtypes of otitis media and what they are differentiated by .
Acute otitis media (AOM)-acute signs of infection
Otitis media with effusion (OME)-presence of middle ear inflammation
Chronic otitis media-presence of fluid in the middle ear
Give function of ET(eustachian tube)
*protenction from nasopharyngeal secretions
*ventilation
*clearance of middle ear secretions
Outline
OME
OME-collection of non-infected fluid in middle ear without signs of an acute infection
Results from common cold, sore throat or any upper respiratory infection
AOM
Infection of ear with rapid onset presenting with signs of acute inflammation, otalgia, bulging of TM(from otoscopic finding)
Chronic OME
Effusion(dense) of middle ear persisting for >3 months
May have cholesteatoma formation
Etiology if OM
Viral, bacterial , insult, leukocyte, ET abnormalities, resolving cystic fibrosis
Risk factors for OM
Attending day care
Passive smoking
Congenital birth defects
Immunocompromised status
Pathophysiology of OM
- Mechanic obstruction of ET ie tumor
- Non mechanic obstruction
- Impaired cilia syndrome
- Clearance and defense dysfunction
- Weakness of related muscle
Bacteria causing AOM
S.pneumonia
H. Influenza
M.catarrhalis
Haemolytic streptococcus
Classification of OM
Duration of disease(acute, chronic)
Quality of effusion
Serous, mucous, purulent
Appearance of TM ( otoscopic findings)
Clinical Presentation of AOM
Irritability
Tugging to the ear
Otolgia
Upper respiratory tract infection symptoms
Fever
Intense erythema of TM
New onset otorrhoea
Otitis media classification based of TM
Normal TM-translucent, no erythema, handle of malleus vertical
AOM-TM is bulging and red, inflamed and TM white from puss in the middle , handle of malleus not visible
OME-reduced mobility,effusion present , opacification of TM
What is glue ear(chronic mucoid OM)
Hearing loss, thick effusion , no air, opaque/gray
Cholestatoma
Accumulation of squamous epithelium in middle ear and mastoid
Osteolytic enzymes
Often accompanied with chronic otorrhea
Diagnosis of OM
Pneumatic examination
Tympanometry
PCR of middle ear fluid to identify(S.pneumonia, H. Influenza,M.catarrhalis)
Pathogens associated with chronic suppuration OM
P. Aeruginosa
S.aureus
K. Pneumonia
Diphtheroids
AOM-sos scale for young children
Parent asked to rate each of the symptoms twice daily ,during initial 3 days and daily till end of therapy
0=none
1=little
2=a lot
AOM-severity score of symptoms scale assess
7 items
Irritability
Tugging of ear(s)
Increased crying
Disturbed sleep
Diminished activity
Diminished appetite
Fever
Initial Treatment of AOM with no red flag symptoms ie immunocompromised, <6 months, cochlear implant
Resolve spontaneously, use of antibiotics not recommended within first 48 hours
Pain-paracetamol 500mg q12h
Topical analgesic- 1-2 drops of 2%lignocaine
Treatment with red flag of OM
- Amoxicillin 80-90mg/kg in 2 divided doses alternative if allergy cefdinir 14mg/kg per day in 1/2 divided doses
- If treatment failure after 48-72 hours
Amox/clav 90mg/kg w 6.4mg/kg in 2 divided doses alternative ceftriaxone IV 3 days 50mg/kg
Treatment with red flags if child has received amoxicillin within previous 30 days or suspection H. Influenza/Moraxella beta lactamase producing for OM
Amoxicillin-clavulanate 90/6.4 mg/kg/day in 2 divided doses for 10 days alternative
Ceftriaxone 50mg/kg/day IV for 3 days
Or cefuroxime
If treatment fails after 48-72 hours
1. Ceftriaxone
2. Clindamycin 30-40mg/kg/day in 3 divided doses + 3rd gen ceph
Before administering ceftriaxone therapy consider?in OM
Tympanocentesis - to isolate pathogen
If not feasible clindamycin +\or minus cefixime for H. Influenza coverage
Management of OME
Resolves in 2 months
Decongestant-pseudoephedrine 60mg q4-6h
Antihistamine for rhinorrea loratidine 10mg OD
