B3-054 Otitis Media Flashcards
AOM usually occurs with or following
a viral URTI
**eustachian tube dysfunction occurs in 75% of children with viral UTRI
Four bacterial pathogens consistent with AOM
S. pneumoniae
NTHi
M. catarrhalis
S. pyogenes
NTHi otitis media is often seen with
conjunctivitis
risk factors for AOM
daycare attendance
non-hispanic white
atopy
having siblings
family hx of recurrent AOM
breastfeeding is
protective for AOM
AOM usually presents with
rapid onset of pain
in preverbial children, otalgia is suggested by
tugging, rubbing, holding ears
excessive crying
changes in sleep/behavior
which symptom of AOM is most useful in diagnosis?
ear pain
what is the best predictor of AOM using symptom-based diagnosis?
cloudy, bulging TM with impaired mobility
Impaired mobility has [specificity/sensitivity]
high specificity, high sensitivity
TM bulging has [sensitivity/ specificity]
high specificity; low sensitivity
OME may occur
after AOM
due to eustachian tube dysfunction
OME and AOM are segments of
disease continuum
OME may precede
AOM
does OME indicate infection?
no
does OME indicate infection?
no
does OME indicate infection?
no
does OME require antibiotics?
no
moderate-severe bulging of TM
OR
new onset otorrhea
AOM
mild-bulging of TM and recent onset of ear pain
OR
intense erythema of the TM
AOM
clinicians should not diagnose AOM in children who do not have
MEE on otoscopty or tympanometry
bulging of TM or limited/absent motility
Air-fluid level behind TM
otorrhea
MEE
AOM treatment should include a plan for
pain
treatment option for uncomplicated AOM
observation
**based on illness, age, severity, and availability to follow up
severe illness in AOM is considered
moderate to severe otalgia
fever >39
if observation is chosen as the treatment method, what must be in place?
mechanism for followup and plan to start antibiotics if condition worsens in 48-72 hours
observation is an option under two years of age if
AOM is unilateral and not severe
If the child is more than two years old, is observation an option for bilateral AOM?
yes
Antimicrobial therapy is always recommended in AOM with
otorrhea
initial antimicrobial treatment for AOM
amoxicillin
when should you prescribe additional beta-lactamase coverage for AOM?
if the child has received amoxicillin in the past 30 days
OR
has a history of recurrent AOM unresponsive to amoxicillin
when might you use ceftriaxone to treat AOM?
48-72 hours after failure of initial treatment
OR
as an alternative treatment for penicillin allergy
presence of fluid in the middle ear without symptoms of acute infection
OME
____% of children have OME before school age
90
***greater than 50% will experience in first year of life
most episodes of OME resolve spontaneously within
3 months
persistant OME causes
decreased mobility of TM
OME can cause
conductive hearing loss
OME is the most common cause of ________ in children in developed countries
hearing loss
pneumatic otoscopy should be performed in a child with
otalgia, hearing loss, or both
clinicians should document MEE with ________ when diagnosing OME
pneumatic otoscopy
tympanometry should be performed when
diagnosis is uncertain after otoscopy
watchful waiting
managing a child with OME not at risk for 3 months from the date of effusion onset/diagnosis
no antibiotics
no antihistamines/decongestants
no intranasal or systemic steroids
watchful waiting
when should clinician perform a hearing test?
if OME persists longer than 3 months
OR
OME of any duration in at risk child
risk factors for hearing loss with OME
autism, down syndrome, cleft palate, developmental delays
healthy children with persistent OME who do not have at risk criteria can be observed for
6-12 months
clinicians should reevaluate OME at _________ intervals until it resolves or a cause if found
3-6 months
what is recommended when surgery is performed for OME <4 years?
tympanostomy tubes
what is recommended when surgery is performed for OME >4 years?
tympanostomy tubes and/or adenoidectomy
