[12] Acute Otitis Media Flashcards
What is acute otitis media?
Acute inflammation of the middle ear
Who is acute otitis media more common in?
Children
Does acute otitis media only affect children?
No, affects all age groups including neonates
What is the usual underlying cause of acute otitis media?
Infection
How do bacteria and other organisms usually enter the middle ear?
Via the eustachian tube
Why are children more prone to acute otitis media?
The horizontal anatomy of their eustachian tubes
Why is a horizontal eustachian tube a risk factor for bacteria entering the middle ear?
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
What are the common causative bacteria in acute otitis media?
- H. influenzae
- Strep. pneumoniae
- Moraxella catarrhalis
- Strep. pyogenes
What are the common viral pathogens in acute otitis media?
- RSV
- Rhinovirus
What are the risk factors for developing acute otitis media?
- Young age
- Parental/passive smoking
- Previous URTI
- Presence of enlarged adenoids
- Bottle feeding or dummy use
- GORD (in adult)
- High BMI
What is the peak age of risk for acute otitis media?
6-24 months
How does breastfeeding affect the risk of acute otitis media?
It it protective
What are the common symptoms of acute otitis media?
- Pain (otalgia)
- Malaise
- Fever
- Coryzal symptoms
How may otalgia be recognised in young children?
- Tugging the ear
- Irritable
- Disinterested in food
- Vomiting
How may the TM appear on examination of acute otitis media?
- Erythematous
- Bulging
- Small tear with yellow/purulent discharge
When may there be a tear in the TM in acute otitis media?
When the fluid in the middle ear cause a perforation
What features may suggest a ruptured TM in acute otitis media?
Rapidly resolving, extreme pain with ear discharge in auditory canal
What other features may be present in acute otitis media?
- Conductive hearing loss
- Cervical lymphadenopathy
How are most cases of acute otitis media diagnosed?
Clinically
What blood tests may be useful to confirm inflammation and determine treatment response in acute otitis media?
- FBC
- CRP
What should be done to all patients with discharge in acute otitis media?
Culture the discharge
When should blood cultures be considered in a patient with acute otitis media?
If the patient is pyrexial
What are the differentials for acute otitis media?
- Chronic suppurative otitis media
- Otitis media with effusion
- Otitis externa
- Meningitis
- Mastoiditis
- Intra-cranial extension of infection
- Intra-cranial abscess
- Head and neck malignancies
In the majority of cases of acute otitis media resolve?
1 - 3 days
What should all patients with acute otitis media be treated with in the first instance?
Analgesia
Should antibiotics be prescribe in acute otitis media?
Not unless indicated by deterioration or progression
What indicates the need for outpatient treatment with antibiotics in acute otitis media?
- 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
What should be done prior to commencing antibiotics for acute otitis media with ear discharge?
Ensure swabs are taken
What is the common antibiotic of choice in acute otitis media?
Amoxicillin
When should admission with acute otitis media be considered?
- Children < 3 months with temp >38
- 3 - 6 months with temp >39
- Evidence of AOM complication
- Systemically unwell child
What are the potential complications of acute otitis media?
- Mastoiditis
- Meningitis
- Facial nerve paresis
- Intracranial abscess
- Sigmoid sinus thrombosis
- Chronic otitis media
