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Flashcards in Otitis Media Deck (11):
1

Peak age prevalence of OM

6-18mo

2

Aetiology of OM

- viral (25%)
• RSV

- Bacterial (75%)
• Streptococcus pneumoniae
• Moraxella catarrhalis
• non-typable strains of Haemophilus influenzae

3

List some risk factors for OM

• Aboriginal  
• Eustachian tube dysfunction  
• Passive smoking, smoke exposure 
• Down syndrome (due to different anatomy of Eustachian tube) 
• Cleft palate (95% require grommets long-term) 
• Using a pacifier  
• Cystic fibrosis 
• Primary ciliary dysfunction 
• GORD  
• Immunoglobulin deficiency 

4

Cf pathophysiology of OM vs otitis externa.

- OM: eustachian tubes in children are more horizontal, making it easier for bacteria to enter middle ear from nasopharynx, and harder for them to exit!

- Otitis externa: usually due to excess moisture in the canal, e.g. after swimming, or damage to the canal after use of cotton buds or scratching.

5

List some clinical features of OM.

- Triad of:
• Otalgia esp. pulling at ear/irritability in pre-verbal children
• fever (especially in younger children)
• conductive hearing loss

• May have:
• Anorexia
• rarely tinnitus, vertigo, and/or facial nerve paralysis
• otorrhea if tympanic membrane perforated
• Associated viral Sx: coryza, red tonsillopharynx, cough, lethargy etc.
• Sx more associated with bacterial infection:
○ Yellow discoloration/discharge
○Vomiting

6

What are some findings on otoscopy in OM?

- The usual middle ear landmarks (handle of malleus, incus, light reflex) are not well seen
- Injected vessels
- Convex TM
- TM opacification and myringitis (erythema), bulging with marked discoloration (e.g. haemorrhagic, grey, yellow)
- Air fluid level may be seen

7

List some complications of OM

• Hearing loss
• Chronic otitis media/recurrent otitis media (ROM)
• Esp. cholesteatoma
• Febrile convulsions
• Suppurative complications uncommon:
• mastoiditis, suppurative labyrinthitis or intracranial infection (meningitis, extradural or subdural abscess, brain abscess)
• facial nerve palsy
• lateral sinus (venous) thrombosis
• benign intracranial hypertension
• Infection of grommet  

8

How do we manage acute OM? How does this differ from otitis externa?

- 80% cases of AOM in children resolve spontaneously (regardless if viral/bacterial)
- Cf otitis externa: always need to be treated with abx drops

- > 12mo, mildly unwell: analgesia paracetamol 24-48h -> amoxy if not improving
- <12mo: amoxy 15mg/kg/dose TDS 5 days
- If not improving, review Dx or switch co-amoxyclav

- Advise parents to r/v if persistent irritability/hearing diff/ear Sx after 2-3 months

9

What are some common forms of chronic OM?

Tympanosclerosis  

Adhesive otitis media
• End-stage glue ear 
• No middle ear space remaining 
• Grommet will most likely be ineffective 

Chronic suppurative otitis media 
• Perforations of ear drum 
• Discharge in middle ear 
• Treated by grafting procedure 

Cholesteatoma
• Most serious form 
• Collection of keratin and skin 
• Begins with retraction pockets due to negative pressure → desquamation of skin into pocket, which gradually enlarges and has a destructive process of the structures in the middle ear

10

What are risk factors for OM with effusion?

• Parental smoking**
• Limit dummy use for settling

11

How can we manage OM with effusion?

Grommet stays in for 9-12 months → automatically pushed out into the ear canal when ear drum grows over