Otitis media

Question 1

MEE

Answer 1

middle ear effusion

Question 2

OM

Answer 2

otitis media

Question 3

AOM

Answer 3

acute otitis media

Question 4

important vaccinations for OM

Answer 4

non-typable H. infleunza, strep. pneumonia (PVC7, PVC10, PCV23)

Question 5

peak incidence of OM

Answer 5

6-18 months

Question 6

epidemiology

Answer 6

age s syndrome, etc), nasopharyngeal masses (in adults, asian)

Question 7

what is the most common predisposing factor for OM?

Answer 7

viral infections (winter or early spring common seasons)

Question 8

what decreases risk of OM

Answer 8

breastfeeding

• antibodies from breast milk
• musculature from breastfeeding, and coat mouth with anti-bacterial

Question 9

what kind of respiratory epithelium are in the ear?

Answer 9

pseudostratified ciliated columnar epithelium with goblet cells

Question 10

what is the angle of ET in infant?

Answer 10

10 degrees

Question 11

what is the angle of ET in adult?

Answer 11

45 degrees

Question 12

how to get OM

Answer 12

inflammation that effects ET (from URT or allergy)-> ET obstruction-> middle ear effusion-> AOM-> OME-> and either resolution of complications

Question 13

functions of ET in middle ear

Answer 13

protection, drainage, ventilation

Question 14

behind the tympanic membrane, what is the pressure?

Answer 14

negative pressure

-if pop ears, open ET and if bacteria are in nasopharynx, get sucked into the middle ear

Question 15

can you catch Otitis media?

Answer 15

If they still have the viral infections, yes

but can’t catch OM

Question 16

top 3 bacteria for OM

Answer 16

strep. pneumoniae
H. influenza
Moraxella catarhallis

Question 17

how to culture middle ear fluid?

Answer 17

aspirate through tympanic membrane

Question 18

less important bacteria for OM

Answer 18

group A strep
staph. aureus
anaerobes
chlamydia
TB
diphtheria
tetanus 
fungus (chronic OM)

Question 19

what viruses for OM

Answer 19

adenovirus
rhinovirus
influenza
RSV

Question 20

AOM symptoms/history

Answer 20

Pain
URI
fever
headache (older children)
irritiability, apathy
anorexia
V
diarrhea

Question 21

OME history

Answer 21

behavior changes
communication problems
plugged ears
popping of ears
recent URI or allergy symptoms

Question 22

reasons for Otalgia (ear pain)

Answer 22

-otitis externa (swelling of thin epithelium of external auditory canal)
TMJ
dental problems
pharyngitis

Question 23

reasons for Ottorhea (fluid out of ear)

Answer 23

otitis externa

Question 24

reasons for hearing loss

Answer 24

EAC impaction, sensorineural

Question 25

reasons for vertigo, nystagmus, tinnitus

Answer 25

ET dysfunction, labyrinthitis

Question 26

reasons for postauricular swelling

Answer 26

mastoiditis lymphadenitis

Question 27

reasons for facial paralysis

Answer 27

bell's palsy

Question 28

physical exam for OM

Answer 28

signs of sepsis (alert or what) head-> craniofacial abnormalities eye drainage nose-> polyps, septal deviation, congestion, drainage throat (do last)-> bifid uvula, redness, drainage, masses neck-> masses, lymph nodes, meningismus

Question 29

first thing to exam on a child?

Answer 29

heart and lungs

Question 30

fever and earache

Answer 30

suspect pneumococcal infection

Question 31

otitis conjunctivitis syndrome or bilateral otitis

Answer 31

suspect H. influenza

Question 32

tympanic membrane perforation or mastoiditis

Answer 32

suspect group A strep

Question 33

normal tympanic membrane

Answer 33

clear, light reflex, pearly grey

Question 34

what are the purpose of ear tubes?

Answer 34

drainage or any fluid that could accumulate, acts as an external ET

Question 35

tympanometry, acoustic reflectometry

Answer 35

either pressure or sound to show movement of the TM

Question 36

AOM treatment for symptom relief

Answer 36

topical anesthetics analgesics local heat antimicrobial treatment

Question 37

antimicrobial treatment

Answer 37

amoxicillin amoxicilin clavulanate, cephalosporins, macrolides, erythromycin sulfisoxazole, trimethoprim silfamethosazole -less than 6 months old, definitely treatment -older than 2, observation

Question 38

what to do for recurrent OM?

Answer 38

treat AOM antibiotic prophylaxis (amoxicillin or sulfisoxazole, 1/2 dose daily) -if recurrent, myringotomy with tympanostomy tubes -in adults-> image for masses -frequent infections are more than 3 episodes a year

Question 39

OME treatment

Answer 39

observe unless an infant -antibiotics if effusion less than 3 months -surgery-> tubes, andeoidectomy monitor hearing, speech and language

Question 40

requirements for insurance to pay for surgery

Answer 40

``` effusion less than 4-6 months bilateral effusion less than 21 dB hearing loss high risk immunodeficiency long history of ear infections ```

Question 41

when is speech and language at risk?

Answer 41

infant less than 6 months old craniofacial disorder developmental delay

Question 42

how many still have effusion?

Answer 42

40% after 1 month | -10% after 3 months after AOM

Question 43

some complications from OM

Answer 43

``` hearing loss (most common) mastoiditis perforation chronic suppurative OM cholesteatoma facial paralysis suppurative labyrinthitis and petrositis meningitis extradural abscess subdural empyema lateral sinus and carotid artery thrombosis brain abscess otitic hydrocephalus ```

Question 44

prevention from OM

Answer 44

- not smoke around children - breastfeeding - vaccinations - probiotics - xylitol sugar - observation - decreased length of therapy