AOM

Question 1

Viral causes of AOM (20% of cases)

Answer 1

RSV, rhinovirus, influenza

Question 2

Bacterial causes of AOM (80% of cases)

Answer 2

S. pneumoniae, H. influenzae, M. catarrhalis

Question 3

AOM risk factors

Answer 3

<2yo, daycare, recent URTI, smoke exposure, bottle feeding, pacifier use, sick siblings

Question 4

s/s of AOM

Answer 4

middle ear effusion
acute onset of: fever, rhinorrhea, irritability, otalgia, tugging/rubbing of ear
tympanic membrane appears erythematous, cloudy, white, bulging

Question 5

s/s otitis media w/ effusion

Answer 5

uninfected middle ear effusion
w/o acute onset of symptoms
can precede/follow AOM

Question 6

AOM definition

Answer 6

rapid onset of s/s of inflammation in middle ear

Question 7

severe AOM

Answer 7

AOM with moderate to severe otalgia or fever >/ 39C (102.2F)

Question 8

non-severe AOM

Answer 8

AOM with mild otalgia and temp <39C (102.2F)

Question 9

recurrent AOM

Answer 9

> /3 separate AOM episodes in 6mo
OR
/4 episodes in 12mo including 1 in past 6 mo

Question 10

otitis media with effusion (OME)

Answer 10

inflammation of middle ear with liquid collection but no signs of infection

Question 11

chronic suppurative otitis media

Answer 11

continuing inflammation for at least 6 weeks, leading to perforated tympanic membrane and otorrhea

Question 12

AOM analgesia treatment

Answer 12

APAP: 10-15 mg/kg po q4-6h
max 75 mg/kg/day
IBU: (>6mo) 10 mg/kg po q6-8h
max 40 mg/kg/day

Question 13

When to use Antibiotics for AOM:

Answer 13

moderate to severe s/s (otalgia >/48 hrs, temp >/39*C)
OR
<2yo and bilateral AOM

otorrhea = abx

Question 14

Antibiotics OR Obs for AOM:

Answer 14

Children 6-23mo w/ unilateral AOM
OR
children >24mo w/ unilateral or bilateral AOM
(without severe s/s)

Question 15

1st line abx for AOM

Answer 15

Amoxicillin and Amox/Clav
90 mg/kg/day (2 doses)

Question 16

AOM Amoxicillin use

Answer 16

80-90 mg/kg/day in 2 doses
has NOT received amoxicillin in last 30 days
does NOT have purulent conjunctivitis
is not allergic to penicililin

Question 17

AOM Amox/Clav use

Answer 17

90 mg/kg/day in 2 doses
has received amoxicillin in last 30 days
purulent conjuntivitis
hx of recurrent AOM unresponsive to amox

Question 18

Alternative therapy for AOM if allergy

Answer 18

non-life threatening Penicillin allergy: po cephalosporin
life-threatening penicillin allergy: macrolide (azithromycin), clindamycin

OR Ceftriaxone 50 mg/kg IV x1

Question 19

duration of treatment for AOM

Answer 19

severe or <2yo: 10 days
2-5yo : 7 days
>/6yo: 5-7 days

Question 20

when to reassess AOM

Answer 20

if symptoms worsen or do not improve in 48-72 hrs

Question 21

failure of initial treatment of AOM?

Answer 21

Augmentin 90 mg/kg/day in 2 doses
Ceftriaxone 50 mg/kg IV qd x3d
Clindamycin 30-40 mg/kg/day in 3 doses

Question 22

recurrent AOM treatment

Answer 22

tympanovstomy tubes
adenoidectomy

Question 23

AOM prevention

Answer 23

influenza vaccine, pneumococcal vaccine, limiting pacifier use