Acute Otitis Media

Question 1

Acute Otitis Media is the presence of __________ in the middle ear accompanied by the rapid onset of signs and symptoms of an ear infection

Answer 1

INFLAMMATION

Question 2

AOM is most common in ______

Answer 2

children 6 months - 3 years
Peak incidence between 6-18 months (<2 yo)
Uncommon after 8 years of age

Question 3

AOM is often preceded by a _____ or ______ respiratory tract infection

Answer 3

viral or bacterial

Question 4

Up to 50% of AOM cases are due to viral causes and resolve without antibiotic therapy, examples include:
1.
2.
3.

Answer 4

1. RSV
2. Influenza
3. Coronavirus

Question 5

Most common pathogens involved in AOM
1
2
3

Answer 5

1. S. Pneumoniae
2. H. Influenzae
3. M. Catarrhalis

Question 6

These two pathogens _________ / __________ are likely to resolve spontaneously

Answer 6

H. Influenzae / M. Catarrhalis

Question 7

3 Most common symptoms of AOM include
1.
2.
3.

Answer 7

Otalgia (ear pain), Irritability, fever (absent in 50% of cases)

Patients may also experience nasal congestion, cough, loss of appetite, vomiting and discharge

Question 8

Mild AOM is defined as the absence of ____ or _____ and an oral temperature < ____

Answer 8

pain or mild pain
<39

Question 9

Sever AOM is defined as ______ on the ear or inability to sleep and redness or oral temperature _____

Answer 9

tugging or inability to sleep / > 39

Question 10

The most common complication of AOM is ____ ______

Answer 10

Acute mastoiditis

Question 11

Diagnosis of AOM is certain if the following are present: 1. 2. 3.

Answer 11

1. Acute onset 2. Middle-ear effusion 3. middle ear inflammation

Question 12

Recurrent AOM is defined as >3 episodes in 6 months or ___ episodes in ___ months

Answer 12

4 episodes in 12 months

Question 13

Risk factors for AOM
1.
2.
3.
etc

Answer 13

1. Age (peak 6M - 3 yo)
2. Childcare attendance or presence of siblings in home
3. second hand smoke
4. asthma
5. recent episode of influenza/URTI
6. Indigenous
7. Family history of recurrent OM
8. Low socioeconomic status
9. Immunocompromised
10. Breastfeeding while lying down

Question 14

The most effective vaccination for reducing AOM for children >2 is _________

Answer 14

Influenza

S pneumoniae vaccine in childhood also helps

Question 15

AOM diagnosed in > 6 month old, healthy child with NON SEVERE ILLNESS & SYMPTOMS FOR <48 hr should be considered for this approach:

Answer 15

watchful waiting for 1-2 days with antibiotic prescription on hand, if worsening or not improved treat with antibiotics

Question 16

AOM diagnosed in > 6 month old, healthy child with MODERATELY/SEVERELY ILL or SYMPTOMS for >48 hr should get

Answer 16

antibiotic treatment

Question 17

AOM diagnosed in babies 6 weeks - 6 months of age automatically should be treated with

Answer 17

antibiotics

Question 18

Severe AOM is considered as moderate to severe _____ and fever >39

Answer 18

otalgia (ear pain)

Question 19

Watchful waiting can be considered in the first 1-2 days in children >6 months of age with the following:
1
2.
3.
4.

Answer 19

1. non severe illness
2. uncomplicated
3. no serious comorbidities
4. guardian is able to recognize when illness is worsening

Question 20

Duration of therapy for AOM
1. > 2 yo (uncomplicated) =
2. < 2 yo =

Answer 20

1. 5 days
2. 10 days (also for recurrent AOM, or AOM + perforated tympanic membrane or treatment failure)

Question 21

First line antibiotics for AOM treatment:
1.
2
3

Answer 21

Amoxicillin (SD/HD)
Cefuroxime
Ceftriaxone

Question 22

High dose amoxicillin in AOM is used to over come _____

Answer 22

Strep Pneumoniae resistance

Question 23

High dose amoxicillin in AOM should be considered if the patient:
1.
2.

Answer 23

1. has had recent antibiotic exposure <90 days
2. attend daycare or have siblings in daycare

Question 24

Initial treatment failure of AOM (no improvement after 2-3 days) should be treated with:

Answer 24

Amox-Clav

Question 25

If a patient with AOM has Type 1 hypersensitivity aka a life threatening penicillin allergy what alternate treatments can you use
1.
2.
3.

Answer 25

1. Azithromycin
2. Clarithromycin
3. Clindamycin

Question 26

_________ (antibiotic) should be considered for patients who fail amox/clav therapy of AOM

Answer 26

Ceftriaxone

Question 27

AOM

Gram stain shows
Gram neg diplococci or coccobacilli

Assuming limited recent exposures to antimicrobials which of the following antibiotics should not be used empirically for this patient:
a Clindamycin
b Cefuroxime
c Amox-Clav
d Azithromycin

Answer 27

A - Clindamycin DOES NOT have activity against gram negative organisms