Acute Otitis Media Flashcards

1
Q

What is acute otitis media?

A
  • infection of middle ear
  • common in 6-12month olds
  • infants predisposed due to short, horizontal and poorly functional eustachian tubes
  • RFs → day-care attendance, older siblings, young age, FHx, absence of breast feeding, immunological deficiency
  • Ddx → otitis media w/ effusion, myringitis, mastoiditis
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2
Q

What are the signs and symptoms of acute otitis media?

A
  • conductive hearing loss
  • otalgia
  • fever, malaise, N+V
  • otorrhoea in perforation
  • often preceding viral URTI
  • TM examination → dilatation of blood vessels, reddened membrane which is thickened + bulging, may be perforated w/ discharge
  • tenderness of mastoid process
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3
Q

What is the aetiology of AOM?

A
  • viruses → RSV, rhinovirus
  • bacterial → strep pneumoniae (40%), haem influenzae (30%) + moraxella catarrhalis (15%)
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4
Q

Usually no tests are necessary for AOM, condition is diagnosed on clinical examination.

What is the management?

A
  • analgesia → paracetamol, NSAIDs, calpol
  • antibioticsamoxicillin 5-days, IF:
    • symptoms lasting >4days + not improving
    • systemically unwell, but not requiring admission
    • immunocompromised
    • younger than 2yrs w/ bilateral otitis media
    • otitis media w/ perforation and/or dischage in canal
  • surgical management rare → occasionally myringotomy (surgical perforation of TM) or insertion of ventilation tube

Once analgesia and/or antibiotics are initiated, most patients improve quickly over course of 2-3 days

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5
Q

What are the extra-temporal complications of acute otitis media?

A
  • neck abscess
  • intracranial complications → abscess, subdural or extradural collections, meningitis
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6
Q

Some children are particularly susceptible to repeated attacks of AOM. This tends to resolve as child gets older. Repeated attacks can be partially prevented by reduced exposure to passive smoke + by breastfeeding.

What are the risk factors for recurrence?

A
  • Abnormal Eustachian drainage → large adenoids (removal reduces recurrence), cleft palate
  • Down’s syndrome
  • Immunodeficiency
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7
Q

Mastoiditis is an extension of AOM into the mastoid air cells w/ suppuration and necrosis.

What are the clinical features and management of mastoiditis?

A
  • symptoms → pain (persistent + throbbing), otorrhoea, increasing deafness
  • signs → fever, post-auricular swelling + antero-inferior displacement of ear, mastoid tenderness
  • Rx → IV abx: amoxicillin and metronidazole
  • surgery → pus drained under GA
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8
Q

A brain abscess is a particularly morbid complication of AOM. Otogenic abscesses usually occur in the cerebellum or temporal bone and spread occurs via the vasculature or direct extension through bone + meninges. Abscesses may develop rapidly or over several months. Mortality is about 25% (up to 70% if cerebellar).

What is the clinical presentation and treatment?

A

Symptoms caused by:

  • infection → malaise + pyrexia
  • raised ICP → headache, drowsiness, confusion, reduced GCS, papilloedema
  • focal neurological signs → depending on where lesion is

Treatment directed at drainage of abscess. This should take priority over all other conditions. Drainage is via a burr hole, or excised via craniotomy. Vigorous antibiotic follow-up is required.

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