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A - MSRA ENT [6] > [12] Acute Otitis Media > Flashcards

[12] Acute Otitis Media Flashcards

1
Q

What is acute otitis media?

A

Acute inflammation of the middle ear

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2
Q

Who is acute otitis media more common in?

A

Children

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3
Q

Does acute otitis media only affect children?

A

No, affects all age groups including neonates

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4
Q

What is the usual underlying cause of acute otitis media?

A

Infection

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5
Q

How do bacteria and other organisms usually enter the middle ear?

A

Via the eustachian tube

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6
Q

Why are children more prone to acute otitis media?

A

The horizontal anatomy of their eustachian tubes

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7
Q

Why is a horizontal eustachian tube a risk factor for bacteria entering the middle ear?

A

When there is increased pressure (e.g. coughing or sneezing) the eustachian tube is less likely to close and so organisms are forced into the middle ear

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8
Q

What are the common causative bacteria in acute otitis media?

A
  • H. influenzae
  • Strep. pneumoniae
  • Moraxella catarrhalis
  • Strep. pyogenes
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9
Q

What are the common viral pathogens in acute otitis media?

A
  • RSV

- Rhinovirus

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10
Q

What are the risk factors for developing acute otitis media?

A
  • Young age
  • Parental/passive smoking
  • Previous URTI
  • Presence of enlarged adenoids
  • Bottle feeding or dummy use
  • GORD (in adult)
  • High BMI
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11
Q

What is the peak age of risk for acute otitis media?

A

6-24 months

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12
Q

How does breastfeeding affect the risk of acute otitis media?

A

It it protective

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13
Q

What are the common symptoms of acute otitis media?

A
  • Pain (otalgia)
  • Malaise
  • Fever
  • Coryzal symptoms
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14
Q

How may otalgia be recognised in young children?

A
  • Tugging the ear
  • Irritable
  • Disinterested in food
  • Vomiting
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15
Q

How may the TM appear on examination of acute otitis media?

A
  • Erythematous
  • Bulging
  • Small tear with yellow/purulent discharge
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16
Q

When may there be a tear in the TM in acute otitis media?

A

When the fluid in the middle ear cause a perforation

17
Q

What features may suggest a ruptured TM in acute otitis media?

A

Rapidly resolving, extreme pain with ear discharge in auditory canal

18
Q

What other features may be present in acute otitis media?

A
  • Conductive hearing loss

- Cervical lymphadenopathy

19
Q

How are most cases of acute otitis media diagnosed?

A

Clinically

20
Q

What blood tests may be useful to confirm inflammation and determine treatment response in acute otitis media?

A
  • FBC

- CRP

21
Q

What should be done to all patients with discharge in acute otitis media?

A

Culture the discharge

22
Q

When should blood cultures be considered in a patient with acute otitis media?

A

If the patient is pyrexial

23
Q

What are the differentials for acute otitis media?

A
  • Chronic suppurative otitis media
  • Otitis media with effusion
  • Otitis externa
  • Meningitis
  • Mastoiditis
  • Intra-cranial extension of infection
  • Intra-cranial abscess
  • Head and neck malignancies
24
Q

In the majority of cases of acute otitis media resolve?

A

1 - 3 days

25
Q

What should all patients with acute otitis media be treated with in the first instance?

A

Analgesia

26
Q

Should antibiotics be prescribe in acute otitis media?

A

Not unless indicated by deterioration or progression

27
Q

What indicates the need for outpatient treatment with antibiotics in acute otitis media?

A
  • Systemically unwell child not requiring admission
  • Known risk factor for complications e.g. congenital heart disease/immunosuppression
  • Unwell for >4 days without improvement
  • Discharge from ear*
  • Systemically unwell adult that is not septic with no signs of complications
28
Q

What should be done prior to commencing antibiotics for acute otitis media with ear discharge?

A

Ensure swabs are taken

29
Q

What is the common antibiotic of choice in acute otitis media?

A

Amoxicillin

30
Q

When should admission with acute otitis media be considered?

A
  • Children < 3 months with temp >38
  • 3 - 6 months with temp >39
  • Evidence of AOM complication
  • Systemically unwell child
31
Q

What are the potential complications of acute otitis media?

A
  • Mastoiditis
  • Meningitis
  • Facial nerve paresis
  • Intracranial abscess
  • Sigmoid sinus thrombosis
  • Chronic otitis media

A - MSRA ENT [6] (22 decks)

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