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ICM - Infectious Disease > Otitis Media > Flashcards

Otitis Media Flashcards

(60 cards)

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1
Q

What is a middle ear effusion

A

Fluid in the middle ear

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2
Q

When a patient has otitis media with effusion, what characters of the fluid should be noted

A

Serous, Mucoid, or Purulent

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3
Q

Is Otitis Media very common?

A

yes.
Most common reason for AB therapy
Most common diagnosis in sick children in the US

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4
Q

Risk Factors for Otitis Media (10)

A 
Less than 6 yo
Family History
Male
Poor
Alaskan, American, Australian indigenous population
Craniofacial anomalies, nasopharyngeal mass
Cold Season 
Smoke Exposure
Day Care
Pacifier Use
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5
Q

What factor may decrease the likelihood to AOM in children?

A

Decreased risk in breastfeeding children

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6
Q

Why is a blockage of the eustachian tube such a big deal?

A

It can allow negative pressure to build up in the middle ear. When it opens up, the pressure sucks all the contaminated material into the middle ear.

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7
Q

Oval Window goes to….

Round window goes to….

A

Inner Ear

Mastoid Air Cells

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8
Q

Cell type in respiratory epithelium

A

Pseudostratified ciliated columnar epithelium w/ Goblet cells

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9
Q

Functions of the Eustachian tube in the middle ear

A

Protection
Drainage
Ventilation

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10
Q

If a patient has recurrent infections with OM, what should you consider

A

Getting a CT to look for a physical blockage of the eustachian tube.

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11
Q

Describe the average pathogenesis of otitis media.

A

Inflammation -> Eustachian tube destruction -> Middle ear effusion –> AOM –> OME –> Resolution or Complications

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12
Q

Three bacteria that most commonly cause AOM

A

Streptococcus pneumoniae
Haemophillus influenzae (non-typable)
Moraxella catarhallis

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13
Q

Most common cause of community acquired pneumonia

A

Strep pneumoniae

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14
Q

Common pieces of an AOM patient history

A

PAIN
URI, Fever, Headache
Irratability, Apathy
Anorexia, Vomiting, Diarrhea

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15
Q

Common pieces of OME history

A 
Behavior changes
Communication Problems
Plugged Ears
Popping Ears
Recent URI or Allergy Symptoms
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16
Q

Five causes of Otalgia?

A 
Otitis externa (Swimmers ear)
Ramsay-Hunt (Shingles in auditory canal)
TMJ
Dental Probs
Pharyngitis (Sensory confusion)
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17
Q

DDx concerns for Vertigo, Nystagmus, Tinnitus

A

Eustachian tube dysfunction

Labrynthitis

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18
Q

DDx concerns for Postauricular swelling

A

Mastoiditis

Lynphadenitis

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19
Q

DDx concerns for Facial paralysis

A

Bell’s Palsy (can be caused by inflammation from AOM)

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20
Q

Important AOM findings on physical exam. General Appearance.

A

Sepsis (general lethargy)

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21
Q

Important AOM findings on physical exam.Head.

A

Craniofacial abnormalities

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22
Q

Important AOM findings on physical exam. Eyes.

A

Drainage, haemophilus (non typable)

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23
Q

Important AOM findings on physical exam. Nose.

A

Polyps, Septal Deviation, Congestion, Drainage

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24
Q

Important AOM findings on physical exam. Throat.

A

Bifid Uvula, Redness, Drainage, Masses

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25
Important AOM findings on physical exam. Neck.
Masses, Lymph Nodes, Meningismus
26
What is meningismus
Stiff neck
27
AOM Tympanic Membrane Triad
Bulging, Immobile, Red
28
Bubbles seen in TM imply...
Fluid build up with intermittent opening of nasopharynx
29
What are bullae in TM?
Blisters/Vasicles --> the stretching from fluid expanding is very painful
30
What is a cholesteatoma?
A growth of keratinous squamous epithelium that forms a benign tumor that if left alone can erode into ossicles and through the TM
31
If a patient presents with OM and a fever+earache, you should suspect...
Pneumococcal infection
32
If a patient presents with OM with otitis conjunctivities or bilaterally, you should suspect
H. flu
33
If a patient presents with tympanic embrane perforation of mastoiditis
Group A Strep
34
The big diagonal bar you see on tympanic membrane exam (_________) splits the membrane into ______
Manubrium of Malleus | Anterosuperior, Anteroinferior, Posterosuperior, Posteroinferior Quadrants
35
Name the bump at the bottom of the Manubrium
Umbo
36
Posteroinferior quadrantis where _____ cna be found
Pars tensa
37
What does it look like when you see an Air Fluid level in a tympanic membrane
The membrane appears translucent above and opaque below a line demarcating the separation
38
Which one is the Weber and Rinne test?
Weber on the forehead | Rinne for each ear
39
Special studies that sometimes occur in AOM patients
Tympanometry Acoustic reflectometry Audiometry Tympanocentesis/Myningotomy
40
What the tympanometry measure
The impedance of the membrane
41
When there is negative pressure in the middle ear cavity, the position of the tympanic membrane will be...
retracted
42
AAP Guidelines for diagnosis of AOM
``` Acute History (recent URI, congestion) Evidence of middle ear effusion (Drainage, bulging TM, abnormal tympanometry) Signs and/or Symptoms (Fever, Pain) ```
43
AOM symptomatic relief may include...
Topical Anesthetic, Analgesics, Local Heat
44
Treatment of choice for AOM...
Amoxicillin (Amox. clavulanate for haemophilus. Cephlosporins as a back up) 10 day treatment course
45
When can you provide a treatment course shorter than 2 days?
Patients over 2 years old with no risk factors
46
How long should it take for antibiotics to have an effect?
24-48 hours. | Recheck in 10-14 days.
47
Treatment for recurrent OM?
Antibiotic prophylaxis -- Amoxicillin or sulfisoxasole half dose Image adults for masses Consider myringotomy with tympanostomy tubes
48
Who is especially likely to need surgery
``` Young age (first episode under 6 months old) Frequent infections (more than 3/year) ```
49
Important considerations in Recurrent OM
Be certain to monitor hearing, speech, and language
50
OME treatment
Observe (unless infant) Trial full course of ABs if effusion lasts over 3 months Surgery
51
What would you decide surgery for OME was necessary
Effusion lasting 4-6 months Bilateral effusion More than 21 dB hearing loss High Risk
52
Groups especially at risk for loss of speech and language.
``` Infants under 6 months Patients wth existing hearing loss or speech/language disorder Autism Craniofacial disorder Developmental Delays Uncorrectable visual impairment ```
53
What does a grommet tube do
Holds the TM open until the healing pushes it out
54
What should you see in OM patients with grommet tubes
Otorheea
55
Prognosis for AOM
20% resolve spontaneously Effusion there in 40% one month later 10% 3 months after 20% have recurrent episodes.
56
Most common AOM complications (Top 7)
``` Hearing Loss Mastoiditis Perforation Chronic Suppurative Otitis Media Cholesteatoma Facial Paralysis Suppurative labyrinthitis and petrositis ```
57
Retractions of the tympanis membrane increase likelihood of....
Choleastoma
58
Five causes of blockage in the ear canal
``` Subperiosteal Abscess Extradural abscell Subdural Empyema Brain Abscess Meningitis Lateral Sinus Thrombosis ```
59
How to prevent AOM...
Parental Education Chemoprophylaxis Surgery
60
Important components of AOM parental education
NO Smoking Breastfeed Vaccines (PCV-13) Fewer Children in care setting for high risk kids

ICM - Infectious Disease (11 decks)

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