Flashcards in Otitis Media Deck (11):
Peak age prevalence of OM
Aetiology of OM
- viral (25%)
- Bacterial (75%)
• Streptococcus pneumoniae
• Moraxella catarrhalis
• non-typable strains of Haemophilus influenzae
List some risk factors for OM
• 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
• Immunoglobulin deficiency
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.
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:
• 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
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
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
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
What are some common forms of chronic OM?
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
• 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
What are risk factors for OM with effusion?
• Parental smoking**
• Limit dummy use for settling