16. AOM and OME Flashcards
Highest incidence of OM occurs between the ages of ___ and decreases w age
6-11 mo
What are the signs and symptoms of AOM that differentiate it from MEE
Signs: bulging of the TM, erythema of the TM, and acute perforation of the TM
Sx: Otalgia, irritability, fever
What causes intermittent opening of the eustachian tube which leads to equilibation with atmospheric pressure?
Contraction of the tensor veli palatini muscle during swallowing, jaw movements, and yawning
3 MC pathogens of AOM
S pneumoniae
H influenzae
Moraxella
What anti pneumococcal vaccine is recommended for all children 2-59 mo, as well as children 60-71 mo with increased risk
Prevnar 13
conjugated vaccine, pneumococcal polysaccharides conjugated to nontoxic mutant of diptheria toxin
**pneumovax does not elicit appropriate response in children
What is the only viral vaccine used for the prevention of AOM
Influenza
When is observation an option for AOM?
Nonsevere unilateral AOM (6-23 mo)
Nonsevere unilateral or bilateral AOM (>24 mo)
**WITH pain management
What is the definition of nonsevere AOM
Mild otalgia for <48 hr
Temp <39
What is first line antibiotic therapy for AOM
Amoxicillin (80-90 mg/kg/day divided into 2 doses)
When is augmentin recommended for AOM?
Children who have been treated with amoxicillin in the past 30 days
Those with concurrent purulent conjunctivitis OR
History of recurrent AOM refractory to amoxicillin
What should be used for AOM in the setting of penicillin allergy?
Cephalosporins – cefdinir, cefuroxime, cefodoxime, ceftriaxone
What is the definition of recurrent otitis media?
3 or more in 6 mo
4 or more in 12 mo
What is the benefit and drawback of an anterosuperior tube placement (vs anteroinferior)?
longer tube life
more difficult to repair a persistent perforation
What is the average life of an Armstrong tube?
1 yr
50% extruded in 12 mo
75% extruded by 18 mo
What is the incidence of perforation after tube extrusion
5%
**higher for longer term tubes
