Acute Otitis Media (AOM) and treatment Flashcards
What is Acute Otitis Media
sudden onset of ear pain with middle ear effusion, erythema with moderate to severe bulging of the TM, or a new onset of otorrhea not caused by otitis externa.
What assessment findings will you find with AOM?
moderate or severe otalgia (tugging, pulling or rubbing of ear) irritability INTENSE erythema of the TM (definitive characteristic) Decreased TM mobility (hypomobility) distorted landmarks displaced light reflex cloudy, dull or opaque TM moderate to severe BULGING of TM fever: temp > 102.2 nausea and vomiting dizziness and diminished hearing otorrhea or discharge if perforation ear drum can be yellow/amber with serous otitis media (pre cursor to AOM)
What assessment findings do you see with Otitis media with effusion?
usually asymptomatic Dull TM Decreased motility visible air fluid interface visible air bubbles diminished hearing
Do you treat Otitis media with effusion with antibiotics?
NO
Acute Otitis Media
supparative (purulent) effusion of the TM, infection with pus formation behind the TM
Bullous myringitis
bullae form between the layers of the TM, pressing outward into ear canal
Persistent Acute OM
the treated acute OM never gets better or returns within 1-2 days after finishing antibiotics
Recurrent acute OM
three separate cases of acute otitis media in six months or six cases within 12 months
Needs referral to ENT for possible tympanostomy ear tubes
Where do central perforations of the ear drum occur?
Pars tensa
Marginal perforations occur here?
annulus in the upper region of the ear
How long do tympanostomy tubes last before they fall out of the ear?
12-18 months
Pearly white or cheese-like lesion embedded in the TM
overgrowth of the epidermal tissue in the middle ear
Cholesteatoma
What are signs of cholesteatoma?
tinnitus (ringing in the ear)
unilateral conductive hearing loss
discharge in the canal
** if patient has these symptoms refer to ENT
Does scarring of the TM affect hearing or cause long term effects?
NO
Diagnosis of Acute Otitis Media should be made if these features are seen?
Middle ear effusion bulging Poor mobility Air fluid level discharge cloudiness of the TM Signs of middle ear inflammation: like erythema and otalgia indicate an ear infection and should be treated.
What three components are required by the AAP and AAFP clinical practice guidelines for the diagnosis of Acute Otitis Media?
- Recent, abrupt onset of signs and symptoms of middle ear inflammation and effusion (i.e. ear pain, irritability, otorrhea and/or fever)
- Middle ear effusion (MEE) as confirmed by Bulging TM; limited or absent mobility by pneumatic otoscopy; air-fluid level behind TM; otorrhea
- Signs and symptoms of middle ear inflammation as confirmed by distinct ERYTHEMA of the TM or distinct otalgia interfering with normal sleep or activity.
What criteria must be met to ONLY do observation in child with AOM?
Parent must be able to communicate with clinician obtain the antibiotics if needed bring child in for re-evaluation in 48-72 hours Child must be otherwise healthy and: 6 months-2 years with non severe illness AND uncertain diagnosis OR 2 years old without severe symptoms OR an uncertain diagnosis
What is criteria for treatment in infants <6 months?
Antibacterial therapy with certain AND uncertain diagnosis and analgesics
What is criteria for treatment of child 6 months- 2 years with AOM
Certain diagnosis= antibacterial therapy
Uncertain diagnosis= antibacterial therapy if severe illness; observation option if non severe illness; analgesics
What is criteria for treatment of child > 2 years with AOM?
certain diagnosis: antibacterial therapy if severe illness; observation option if non severe illness
Uncertain diagnosis: observation option and analgesics
What is treatment of AOM if child <2 years old
treat with amoxicillin 90mg/kg/day for 10 days
if this doesn’t work then step up to Augmentin
What is treatment of AOM if child >2 years old
treat with amoxicillin 90mg/kg/day for 5 days
What are analgesics used for pain control of AOM?
acetaminophen ibuprofen >6 months of age warm or cold oil distraction auralgan (ONLY with intact TM)
What are ways parents can prevent AOM?
breastfeeding licensed daycare with fewer children avoidance of supine bottle feeding avoid pacifier use > 6 months of age eliminate smoke exposure
