Acute Otitis Media Flashcards
What is acute otitis media?
- 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
What are the signs and symptoms of acute otitis media?
- 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
What is the aetiology of AOM?
- viruses → RSV, rhinovirus
- bacterial → strep pneumoniae (40%), haem influenzae (30%) + moraxella catarrhalis (15%)
Usually no tests are necessary for AOM, condition is diagnosed on clinical examination.
What is the management?
- analgesia → paracetamol, NSAIDs, calpol
-
antibiotics → amoxicillin 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
What are the extra-temporal complications of acute otitis media?
- neck abscess
- intracranial complications → abscess, subdural or extradural collections, meningitis
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?
- Abnormal Eustachian drainage → large adenoids (removal reduces recurrence), cleft palate
- Down’s syndrome
- Immunodeficiency
Mastoiditis is an extension of AOM into the mastoid air cells w/ suppuration and necrosis.
What are the clinical features and management of mastoiditis?
- 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
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?
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.