Acute Otitis Media Flashcards
Who does acute otitis media typically affected?
Children - mostly < 3 years old
Describe the pathophysiology
Nasopharyngeal organisms migrate via Eustachian tube causing bacterial infection in middle ear
Why in infants is it easier for infection from nasopharynx to get into the middle ear?
Pharyngotympanic tube is shorter and more horizontal in infants
And tube can block more easily - compromising ventilation and drainage of middle ear - increased infection risk
What are common organisms that cause the infection?
Haemophilius influenzae Streptococcus pneumoniae Streptococcus pyogenes Viral : Respiratory syncytial virus Rhinovirus
Define acute otitis media
An acute inflammation of the middle ear that may be caused by a bacteria or virus
What are some risk factors for AOM?
Age (peak incidence 6-24 months) Passive smoking Previous URTI Enlarged adenoids More common in boys Bottle feeding Craniofacial abnormalities
What symptoms are associated with AOM?
Otalgia Malaise Fever Irritability, poor feeding, restless Rhinorrhoea
How might infants indicate otalgia?
Pulling or tugging of ear
What signs are seen on examination?
Erythematous and bulging tympanic membrane
Loss of normal tympanic membrane landmarks
Air-fluid level behind tympanic membrane
Pressure may burst tympanic membrane - purulent discharge in canal
Cervical lymphadenopathy
Signs of infection in mouth
What nerve function should be tested?
Facial nerve
What can relieve the pain?
Perforation of the tympanic membrane
What are some differentials?
Otitis media with effusion Otitis externa Mastoiditis Respiratory tract infection alone - may cause reddening of the tympanic membrane Referred pain - especially from teeth Foreign body Cholesteatoma Temperomandibular joint pain
What complications can occur?
Tympanic membrane perforation
Facial nerve involvement
Mastoiditis
Intracranial complications - meningitis, sigmoid sinus thrombosis, brain abscess
Who should be admitted for specialist assessment?
Severe systemic infection
Suspected acute complications e.g meningitis, mastoiditis
Children younger than 3months and temperature of 38 or more
What is the usual treatment plan?
80% resolve spontaneously within 4 days
Regular fluids
Regular analgaesia- paracetamol or ibuprofen
