Acute Otitis Media Flashcards
What is acute otitis media (AOM)?
Inflammation of the middle ear, usually secondary to a bacterial infection spreading from the upper respiratory tract via the Eustachian tube; lasts fewer than 3 weeks.
What is acute suppurative otitis media (ASOM)?
A complication of acute otitis media with perforation of the tympanic membrane and mucopurulent discharge.
What is otitis media with effusion (OME)?
Presence of middle ear fluid without acute signs of infection; causes pain and hearing loss; related to recurrent inflammation and Eustachian tube dysfunction.
What are common risk factors for acute otitis media in children?
Young age (peak in the first year), male gender, daycare attendance, lack of breastfeeding, exposure to tobacco smoke, craniofacial abnormalities, and immunocompromised status.
What additional risk factors are associated with otitis media with effusion?
Atopy/asthma and chronic respiratory conditions such as Kartagener syndrome and cystic fibrosis.
What are typical symptoms of otitis media in children?
Recent onset ear pain, fever, anorexia, vomiting, and aural fullness.
How does the tympanic membrane appear in acute otitis media?
Red, bulging, and tender.
What is a characteristic finding in acute suppurative otitis media?
Mucopurulent discharge due to tympanic membrane perforation.
How does the tympanic membrane appear in otitis media with effusion?
Dull yellow or grey, retracted with loss of the cone of light reflex, and may have a visible fluid level behind it.
What investigations are typically performed for otitis media?
Clinical diagnosis, ear swab for microbiology, and audiological assessment including pure tone audiometry and tympanometry.
What is the usual duration of acute otitis media?
It is a self-limiting disease that typically lasts 3 days to 1 week.
When are antibiotics indicated for acute otitis media in children?
If the child is systemically unwell, has signs of a more serious condition, is at high risk of complications, has otorrhoea, or is under 2 years old with bilateral acute otitis media.
What is the first-line antibiotic treatment for acute otitis media?
Amoxicillin; for penicillin-allergic patients, clarithromycin or erythromycin may be used.
What is the second-line antibiotic for worsening symptoms of acute otitis media?
Co-amoxiclav, especially if symptoms worsen or if the first-choice antibiotic has been taken for at least 2 to 3 days without improvement.
Are decongestants or antihistamines effective in alleviating symptoms of acute otitis media?
No, they have not been shown to alleviate symptoms.
What is the recommended management for otitis media with effusion otitis media with effusion?
Watchful waiting for 3 months with Valsalva manoeuvre to relieve symptoms; antibiotics, steroids, and decongestants have no benefit.
When is surgical intervention indicated for otitis media with effusion?
If hearing loss persists for more than 3 months, there is language delay, craniofacial abnormalities, or a history of recurrent acute otitis media with OME; options include grommet insertion with or without adenoidectomy.
What are potential complications of acute otitis media?
Acute mastoiditis, sensorineural and conductive hearing loss, cholesteatoma, facial nerve palsy, bacterial meningitis, neck and intracranial abscesses, and sigmoid sinus thrombosis.
What is acute mastoiditis?
A rare complication of acute otitis media where infection spreads to the mastoid air cells, leading to abscess formation and potentially life-threatening sequelae.
What are typical clinical findings in acute mastoiditis?
Post-auricular erythema, tenderness, swelling, fluctuance, proptosed auricle, and loss of the post-auricular sulcus.
What is the typical age group affected by acute mastoiditis?
It is most common in children, with the highest incidence in those under 2 years old.
What is the recommended management for acute mastoiditis?
Immediate hospital admission, intravenous antibiotics, and possible surgical intervention such as mastoidectomy.
What is the role of tympanometry in assessing otitis media?
It measures middle ear pressure and compliance, aiding in the diagnosis of middle ear effusions.
How can otitis media affect a child’s hearing?
It can cause conductive hearing loss due to fluid in the middle ear, and recurrent episodes may lead to more permanent hearing impairment.
What preventive measures can reduce the risk of otitis media in children?
Breastfeeding, reducing exposure to tobacco smoke, managing allergies, and ensuring up-to-date vaccinations.
What is the significance of a bulging tympanic membrane in otitis media?
It indicates increased middle ear pressure due to fluid accumulation, commonly seen in acute otitis media.
How does otitis media with effusion differ from acute otitis media?
OME involves fluid in the middle ear without acute infection signs, while acute otitis media includes infection with rapid onset of symptoms.
What is the purpose of grommet insertion in otitis media with effusion?
To ventilate the middle ear, allowing fluid drainage and improving hearing.
Can otitis media lead to speech and language delays in children?
Yes, especially if it causes prolonged hearing loss during critical language development periods.
What is the typical presentation of a child with otitis media?
Ear pain, irritability, fever, and sometimes ear discharge if the tympanic membrane has perforated.
