Acute Otitis Media Flashcards
Acute Otitis Media is the presence of __________ in the middle ear accompanied by the rapid onset of signs and symptoms of an ear infection
INFLAMMATION
AOM is most common in ______
children 6 months - 3 years
Peak incidence between 6-18 months (<2 yo)
Uncommon after 8 years of age
AOM is often preceded by a _____ or ______ respiratory tract infection
viral or bacterial
Up to 50% of AOM cases are due to viral causes and resolve without antibiotic therapy, examples include:
1.
2.
3.
- RSV
- Influenza
- Coronavirus
Most common pathogens involved in AOM
1
2
3
- S. Pneumoniae
- H. Influenzae
- M. Catarrhalis
These two pathogens _________ / __________ are likely to resolve spontaneously
H. Influenzae / M. Catarrhalis
3 Most common symptoms of AOM include
1.
2.
3.
Otalgia (ear pain), Irritability, fever (absent in 50% of cases)
Patients may also experience nasal congestion, cough, loss of appetite, vomiting and discharge
Mild AOM is defined as the absence of ____ or _____ and an oral temperature < ____
pain or mild pain
<39
Sever AOM is defined as ______ on the ear or inability to sleep and redness or oral temperature _____
tugging or inability to sleep / > 39
The most common complication of AOM is ____ ______
Acute mastoiditis
Diagnosis of AOM is certain if the following are present: 1. 2. 3.
- Acute onset 2. Middle-ear effusion 3. middle ear inflammation
Recurrent AOM is defined as >3 episodes in 6 months or ___ episodes in ___ months
4 episodes in 12 months
Risk factors for AOM
1.
2.
3.
etc
- Age (peak 6M - 3 yo)
- Childcare attendance or presence of siblings in home
- second hand smoke
- asthma
- recent episode of influenza/URTI
- Indigenous
- Family history of recurrent OM
- Low socioeconomic status
- Immunocompromised
- Breastfeeding while lying down
The most effective vaccination for reducing AOM for children >2 is _________
Influenza
S pneumoniae vaccine in childhood also helps
AOM diagnosed in > 6 month old, healthy child with NON SEVERE ILLNESS & SYMPTOMS FOR <48 hr should be considered for this approach:
watchful waiting for 1-2 days with antibiotic prescription on hand, if worsening or not improved treat with antibiotics
AOM diagnosed in > 6 month old, healthy child with MODERATELY/SEVERELY ILL or SYMPTOMS for >48 hr should get
antibiotic treatment
AOM diagnosed in babies 6 weeks - 6 months of age automatically should be treated with
antibiotics
Severe AOM is considered as moderate to severe _____ and fever >39
otalgia (ear pain)
Watchful waiting can be considered in the first 1-2 days in children >6 months of age with the following:
1
2.
3.
4.
- non severe illness
- uncomplicated
- no serious comorbidities
- guardian is able to recognize when illness is worsening
Duration of therapy for AOM
1. > 2 yo (uncomplicated) =
2. < 2 yo =
- 5 days
- 10 days (also for recurrent AOM, or AOM + perforated tympanic membrane or treatment failure)
First line antibiotics for AOM treatment:
1.
2
3
Amoxicillin (SD/HD)
Cefuroxime
Ceftriaxone
High dose amoxicillin in AOM is used to over come _____
Strep Pneumoniae resistance
High dose amoxicillin in AOM should be considered if the patient:
1.
2.
- has had recent antibiotic exposure <90 days
- attend daycare or have siblings in daycare
Initial treatment failure of AOM (no improvement after 2-3 days) should be treated with:
Amox-Clav
