Otitis Media

Question 1

When do you give antibiotics for OM

Answer 1

•Patient is below 6 months
•Aboriginal or Torres Strait Islander children
•Cochlear implant
•Suppurative problem
•Only hearing ear
•Immunocompromised

Question 2

Since OM is self resolving without antibiotics, what pain meds would you give?

Answer 2

•Paracetamol 125/5ml TID PRN
•2% Lignocaine drops (1-2) to INTACT eardrum

Question 3

What antibiotics are recommended and when are they necessary?

Answer 3

•Ciprofloxacin drops if cochlear implant
•Amoxycillin 80mg/kg BID 5/7- if NO antibiotic in last 30days, NO concurrent purulent conjunctivitis, NO penicillin allergy
• Amoxi-clavulanate 90/6.4mg/kg if penicillin resistance, aboriginal or had amoxycillin in last 30 days
• Ceftriaxone 50mg/kg IM 3/7 OR Clindamycin 30mg/kg TID if initial antibiotic failure after 48-72 hrs

Question 4

What delayed and immediate therapy would you recommend in cases of penicillin allergy

Answer 4

Delayed-Cefuroxime 10mg/kg BID 5/7 if between 3 months and 2 yrs
Immediate- Cotrimoxazole 4/20mg/kg BID 5/7 if older than 1month

Question 5

If one fails to perform tympanocentesis; how would you cover for Haemophilus influenzae

Answer 5

• Clindamycin +/- Cefixime

Question 6

Antihistamines and decongestants are unnecessary in treatment of AOM. When are corticosteroids indicated?

Answer 6

• Chronic middle ear effusion

Question 7

How do you treat OME after antibiotic failure?

Answer 7

•Surgical intervention
-tympanostomy tubes to equalize pressure and drain middle ear

Question 8

You’re doing great!
Keep going, you’ll be fine

Question 9

What are the indications for tympanostomy tubes? (include Complications)

Answer 9

•Persistent middle ear effusion for more than 3 months
•Failure of antibiotic therapy
•Recurrent (more than 3 episodes in 6months)
•4 or more episodes in 12 months
COMPLICATIONS
•Associated with hearing loss
•Acute mastoiditis
•impending intracranial complication

Question 10

What’s the difference between a mild and severe penicillin allergy? How would you treat this patient?

Answer 10

Mild-rash
•Cephalosporin- Cefuroxime 10mg/kg BID 3/7 if 3mnths-2yrs
Severe- anaphylaxis
Give macrolide
•Clindamycin
•Azithromycin
•Clarithomycin
•

Question 11

What scale is used for AOM diagnosis

Answer 11

AOM- Severity of Symptoms (AOM-SOS)
•tugg at ears (2)
•increased crying (2)
•irritability
•disturbed sleep (2)
•diminished activity
•diminished appetite
•fever