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ICM > 2: Otitis Media > Flashcards

2: Otitis Media Flashcards

1
Q

increased risk of OM with?

A

-age

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2
Q

decreased risk of OM with?

A

breastfeeding - may be position of infant or the passive Ab’s from mom

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3
Q

incidence of OM?

A
  • most common reason for abx therapy
  • most common diagnosis in sick children in US
  • highest incidence 6-18 mo/o
  • by 1y, 60-80% affected
  • by 3y, 90% affected
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4
Q

how does blockage of the eustachian tube cause middle ear infections?

A

-

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5
Q

describe respiratory epithelium - why is it important?

A
  • pseudostratified ciliated columnar epithelium with goblet cells
  • lines eustachian tube, mastoid air cells, and down into lungs
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6
Q

what three functions does the eustachian tube serve for the middle ear?

A
  • protection
  • drainage
  • ventilation
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7
Q

pathogenesis of OM (factors associated)

A
  1. inflammation (URI, allergies)
  2. Eustachian tube obstruction (mass, anatomy, smoke)
  3. middle ear effusion (barotrauma)
  4. (nasopharyngeal contamination) -> AOM
  5. can go to OME or become complicated
  6. OME resolves or becomes complicated
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8
Q

can you catch OM?

A

no - it is not contagious, BUT the respiratory infection that caused it IS contagious

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9
Q

big 3 for OM

A

S. pneumoniae
H. influenzae (non-typable)
M. catarhallis

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10
Q

what are some other bugs that cause OM?

A
  • GAS, S. aureus, anerobes (more common in patients w/ tubes and chronic drainage)
  • mycoplasma, Chlamydia
  • TB, diphtheria, tetanus, fungus
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11
Q

some viruses associated with OM

A
  • HPIV
  • RSV
  • Human metapneumovirus
  • Rhinovirus
  • Adenovirus
  • Coronavirus
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12
Q

how do you get a sample of purulent fluid in OM if necessary?

A

tympanocentesis - needle through tympanic membrane

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13
Q

AOM history -what will you see?

A
  • PAIN
  • URI
  • fever (only in about 1/3 of patients)
  • headache
  • irritability, apathy
  • anorexia/ decreased appetite
  • vomiting
  • diarrhea
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14
Q

OME history - what will you see?

A
  • behavior changes
  • communication problems (not hearing well due to fluid)
  • plugged ears
  • popping ears
  • recent URI or allergy symptoms
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15
Q

ddx: other options for otalgia

A
  • otitis externa
  • Ramsay-Hunt (VZV)
  • TMJ
  • dental problems
  • pharyngitis
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16
Q

ddx: other options for ottorhea

A

-otitis externa

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17
Q

ddx: other options for hearing loss

A
  • EAC (external auditory canal) impaction (could be wax)

- sensorineural

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18
Q

ddx: other options for vertigo, nystagmus, tinnitus

A
  • eustachian tube dysfunction

- labyrinthitis

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19
Q

ddx: other options for postauricular swelling

A
  • mastoiditis

- lymphadenitis

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20
Q

ddx: other options for facial paralysis

A

Bell’s palsy

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21
Q

what to look for on physical exam:

  • general appearance
  • head
  • eyes
  • nose
  • throat
  • neck
A
  • gen: sepsis
  • head: craniofacial abnormalities
  • eyes: drainage
  • nose: polyps (allergies, chronic infection), septal deviation, congestion, drainage - purulent?
  • throat**: LOOK AT LAST - bifid uvula (submucosal cleft palate), redness, drainage, masses
  • neck: masses, lymph nodes, meningismus
22
Q

what to look for on ear exam:

  • external
  • otoscopic
  • AOM TM triad?
A

external: tenderness, swelling
otoscopic: tympanic membrane
- landmarks
- position
- color
- translucency
- mobility

triad: bulging, immobile, red***

23
Q

tympanic membrane abnormalities

A
  • bulging
  • bubbles
  • air fluid levels
  • perforation
  • ottorhea
  • bullae (blisters/vesicles) - very painful
  • tympanosclerosis
  • atrophy
  • retraction pockets
  • cholesteatoma (keratin accumulation - can erode through ossicles and TM in chronic OM)
24
Q

micro associations w/ fever and earache

A

suspect pneumococcal infection

25
Q

micro associations w/ otitis conjunctivitis syndrome or bilateral otitis

A

suspect H. flu

26
Q

micro associations w/ membrane perforation or mastoiditis

A

suspect GAS

27
Q

landmarks in posterosuperior quadrant

A
  • incudostapedial joint

- pars flaccida

28
Q

landmarks in anterosuperior quadrant

A
  • lateral process

- manubrium of malleus

29
Q

landmarks in posteroinferior quadrant

A
  • pars tensa

- umbo

30
Q

landmarks in anteroinferior quadrant

A
  • light reflex
31
Q

treatment of AOE

A

-roll of cotton w/ a wick containing meds: hydrocortizone and antibiotics

don’t give drops if suspect perforation of TM

32
Q

how predictive is redness of OM? what else can it indicate?

A
  • redness along only predictive about 25%

- can also get redness w/ crying, cerumen removal, (baro)trauma

33
Q

special studies: tympanometry

A

-measures impedance of TM - if there is fluid, there will be no TM movement

34
Q

special studies: acoustic reflectometry

A

-sound stimulus to see if TM will move

35
Q

special studies: audiometry

A

-use this to monitor hearing if 3 ear infections in a row

36
Q

special studies: CT/MRI

A

-look for masses, including infectious abscesses

37
Q

other special studies you can do

A
  • tympanocentesis/myringotomy
  • CBC
  • blood culture
  • sed rate
38
Q

AAP guidelines for AOM diagnosis:

A
  • acute history (recent URI, congestion)
  • evidence of middle ear effusion (drainage, bulging TM, abnormal tympanometry)
  • signs and/or symptoms (fever, pain)
39
Q

AOM tx: symptomatic relief

A
  • topical anesthetic
  • analgesics
  • local heat
40
Q

AOM tx: antimicrobial therapy

  • med options
  • how long
  • when you see response
  • when to recheck
A
  • amoxicillin!!
  • amoxicillin clavulanate
  • cephalosporins
  • macrolides
  • erythromycin sulfisoxazole
  • TMX (when allergic to penicillins)
  • 10d
  • short course if > 2y/o and no risk factors
  • response in 24-48h
  • recheck in 10-14d
41
Q

treatment for recurrent OM

A
  • treat for AOM
  • antibiotic prophylaxis (amoxicillin or sulfisoxasole at 1/2 dose) or ENT referral
  • adults - image for masses
  • surgery (myringotomy w/ tympanostomy tubes - young age or frequent infections)
  • monitor hearing, speech, and language
42
Q

AOM tx: observation

A

many of these cases resolve on their own - but can treat b/c there can be severe complications and it keeps patients happy

43
Q

OME treatment

A
  • observe unless infant
  • trial of full course antibiotics if effusion > 3 mo
  • surgery (tubes, adenoidectomy - remove lymphadenopathy next to eustachian tube) - due to concern for hearing loss affecting language
    • effusion > 4-6 mo
    • bilateral effusion
    • > or = 21dB hearing loss
    • high risk
  • monitor hearing, speech, and language
44
Q

speech and language at risk

A

-infant

45
Q

timeline of OME resolution

A
  • 70% still have effusion at 2 w
  • most clears by 4-6 w

anything remaining in there creates risk of another infection

46
Q

type and placement of tubes in TM

A
  • grommet tubes (to help it stay in TM)

- placed inferiorly

47
Q

AOM prognosis

A
  • 20% resolve spontaneously
  • effusion remains in 40% at 1 mo after AOM
  • effusion remains in 10% at 3 mo after AOM
  • 20% will have recurrent episodes
48
Q

AOM complications (long list)

A
  • hearing loss (most common)**
  • mastoiditis
  • perforation
  • chronic supporative OM (could be due to chronic mastoid infection)
  • cholesteatoma (keratin tumor, appears white on TM)
  • facial paralysis
  • supporative labyrinthitis and petrositis (Gradenigo syndrome - signs of increased ICP: papilledema, headache)
  • meningitis
  • extradural abscess
  • subdural empyema
  • lateral sinus and carotid artery thrombosis
  • brain abscess
  • otitic hydrocephalus
49
Q

prevention of AOM

A
  • parental education:
    • NO smoking
    • breastfeeding
    • vaccines
    • fewer children in care setting for higher risk children
  • chemoprophylaxis
  • surgery
50
Q

developments

A
  • observation instead of therapy
  • decreased length of therapy
  • vaccinations
  • xylitol sugar dosed with a gum
  • probiotics, other complementary medical therapies not proven
51
Q

where is one susceptible to cholesteatomas?

A

at areas of retraction in the TM

52
Q

how to differentiate tympanosclerosis from cholesteatoma

A

tympanosclerosis doesn’t change movement of TM, whereas cholesteatoma will cause a mass behind TM that prevents movement of TM

ICM (26 decks)

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