5.3 OM, Mastoiditis Flashcards
what is acute otitis media characterized by
acute onset of symptoms (eg, otalgia or suspected otalgia) with middle ear fluid and significant inflammation of the middle ear.
To diagnose AOM, there must be acute onset of symptoms such as otalgia (or nonspecific symptoms in nonverbal children), signs of a middle ear effusion associated with inflammation of the middle ear (ie, a TM that is bulging and, usually, very erythematous or hemorrhagic, and yellow or cloudy in colour) or a TM that has ruptured.
What is the pathophysiology behind otitis media
eustachian tubes normally ventilate and drain fluid away from the middle ear.
ET dysfunction or obstruction due to a viral infection or other causes of mucosal inflammation can impair this normal mechanism.
The lack of middle ear drainage leads to fluid stasis and, if the fluid is colonized with bacterial and/or viral pathogens, can lead to AOM.
How is OM different than OE
both can have effusions of middle ear but OM has acute inflammation of the middle ear that is not seen in OE
Why are children more predisposed to OM than adults
2
- they acquire viral infections more often than adults
- their ETs are shorter and more horizontal compared with adults
What risk factors increase the chances of getting OM
3
- frequent contact with other kids
- orofacial abnormalities like cleft palate
- first nations
Note
There is a clinical spectrum of middle ear infections associated with the initiation and progression of infection leading to bacterial AOM.
Middle ear fluid from AOM cases often harbour both viruses and bacteria; however, children who experience spontaneous resolution of AOM are likely to have viral infections alone or to have bacterial organisms that are less virulent (eg, Moraxella catarrhalis and some strains of Haemophilus influenzae) compared with Streptococcus pneumoniae and Streptococcus pyogenes (group A streptococci [GAS]).
Thus, the clinical presentation of AOM can vary with the stage of illness (early versus later).
Also, children may or may not progress to overt bacterial AOM depending on which viruses or bacteria are present in the nasopharynx.
What are the three most common bacteria implicated in OM
- S pneumoniae (most common)
- H influenzae
- M catarrhalis
Can OM be dx’d on symptoms alone
no- very nonspecific
leads to over diagnosis
What is necessary on otoscopic exam to confirm dx of OM
middle ear effusion
An effusion is present when there is little or no mobility of the tympanic membrane (TM) when both positive and negative pressure is applied using a pneumatic otoscope
what are characteristics of effusion on otoscopic exam
2
good link in cps article in study guide for OM that under section on diagnostic criteria for AOM has a link for otoscopy technique and dxing AOM
loss of bony landmarks
presence of airr-fluid level
What is the most important diagnostic criteria for OM
bulging tympanic membrane
very specific - can still have cases without but a bulging membrane is very sensitive for OM
An acute perforation with purulent discharge (otorrhea) in the setting of AOM strongly supports a ___ cause.
bacterial
What is the most common complication of AOM
mastoiditis
What clinical symptoms suggest mastoiditis
pain or swelling over mastiod bone (behind ear)
Although AOM is usually accompanied by inflammation of the mastoid air cells (including radiographic changes on computerized tomography), clinical symptoms, such as pain or swelling over the mastoid bone (behind the ear), suggest mastoiditis.
All children with a perforated TM who present with symptoms of AOM should receive what?
Treatment promptly with systemic antimicrobials and examined for associated complications.
