B3.054 Otitis Media Flashcards

1
Q

most common condition for which antimicrobial agents are prescribed in the US for children

A

otitis media

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2
Q

when do children usually get AOM?

A

coincident with or following a viral upper respiratory tract infection

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3
Q

what happens in 75% of kids with an URI

A

Eustachian tube dysfunction

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4
Q

discuss the breakdown of viral vs bacterial AOM cases

A

96% virus and/or bacteria
66% both
27% bacteria alone
4% viruses alone

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5
Q

4 most common bacterial pathogens of URIs

A

S. pneumoniae
H. influenzae
M. catarrhalis
S. pyogenes

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6
Q

what has caused certain serotypes of S. pneumo to decrease?

A

conjugate pneumococcal vaccine

pen resistant isolates also decreased

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7
Q

most likely cause of otitis-conjunctivitis

A

non typeable H. influenzae (NTHi)

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8
Q

best way to confirm AOM

A

tympanocentesis and bacterial culture of middle ear fluid

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9
Q

what factors increase the risk of AOM

A

daycare
non-Hispanic white
atopy (allergies, asthma)
siblings/ fam history of recurrent AOM

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10
Q

risk factors for RECURRENT AOM

A

male sex
day car
fam history
first episode within first 6 mo of life

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11
Q

what qualifies as recurrent AOM

A

> 3 episodes in 6 months or >4 in 1 year

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12
Q

protective against AOM

A

breastfeeding in first 6 months

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13
Q

strong recommendation

A

follow unless a clear and compelling rationale for an alternate approach is present

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14
Q

recommendation

A

prudent to follow but should remain alert to new info and sensitive to patient preferences

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15
Q

option

A

consider the option in their decision making and patient preference may have a substantial role

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16
Q

no recommendations

A

be alert to new published evidence that clarifies balance of benefit vs harm

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17
Q

symptoms of AOM

A

rapid onset of ear pain

preverbal: tugging/rubbing/holding of the war, crying, fever, changes in sleep/ behavior

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18
Q

most useful symptom in AOM diagnosis

A

ear pain
+ likelihood ratio 3-7.3
present in 50-60% of kids w AOM

19
Q

physical signs of AOM

A

cloudy, bulging TM with impaired mobility
impaired mobility highest sensitivity
bulging highest specificity
bulging associated with bacterial pathogen

20
Q

what is OME

A

otitis media w/ effusion

21
Q

distinguish OME from AOM

A

can occur either as an aftermath of AOM or as a consequence of Eustachian tube dysfunction attributable to an URI
can also precede and predispose to development of AOM
segments of a disease continuum

22
Q

does OME benefit from antibiotics? why or why not?

A

no

not an acute infectious process

23
Q

AOM diagnostic criteria

A

moderate to severe bulging of the tympanic membrane or new onset of otorrhea not due to acute otitis externa
ORRR
mild bulging of the TM and recent onset of ear pain or intense erythema of the TM

24
Q

when should you not diagnose AOM?

A

children who DO NOT have middle ear effusion based on pneumatic otoscopy and/or tympanometry

25
Q

how can you detect the presence of MEE

A

bulging of the TM
limited or absent mobility of the TM
air-fluid level behind the TM
otorrhea

26
Q

how does a retracted tympanic membrane in OME appear

A

short process points to 9 o clock instead of 8

27
Q

tenants of AOM treatment

A

assessment of pain

treatment to reduce pain

28
Q

what % of AOMs clear on their own?

A

19% of S. pneumo
48% of H.influenzae
75% M. catarrhalis
cleared 2-7 days after initial tympanocentesis

29
Q

when is there a clinically significant benefit of immediate antimicrobial therapy?

A

bilateral AOM
S. pneumo
AOM with otorrhea

30
Q

how is severe AOM classifies

A

moderate to severe otalgia

fever >39 C

31
Q

when do you have an observational option?

A

> 2 yr old not severe uni or bilateral AOM
6 mo - 2 yr not severe unilateral AOM
no otorrhea

32
Q

most common drug/dose prescribes to children

A

amoxicillin

80-90 mg/kg/day

33
Q

when should you use additional beta lactamase coverage?

A

kids who have had amoxicillin in the past 30 days
purulent conjunctivitis
recurrent AOM unresponsive to amoxicillin

34
Q

what do you do if a patient fails to respond to initial management option within 48-72 hours?

A

reassess, exclude other causes of illness
start antimicrobials if it wasn’t already
switch antimicrobials if they were started already

35
Q

alternative treatment for people w penicillin allergies

A

cephalosporin

more broad spectrum, more expensive, and not necessarily better

36
Q

define OME

A

present of fluid in the middle ear without signs or symptoms of acute ear infection
may occur during URI from poor Eustachian tube function or as an inflamm response following AOM

37
Q

what % of people get OME

A

90% of kids before school age

>50% in first year of life

38
Q

how long does OME usually last?

A

most resolve within 3 months
30-40% of kids can have repeat episodes
5-10% of episodes last >1 year
25% of OME episodes last >3 mo

39
Q

what is a consequence of OME?

A

persistent OME results in decreased mobility of the TM and serves as a barrier to sound conduction
most common cause of hearing impairment in children in developing countries
perm hearing loss prevalence 2-35 per 100,000

40
Q

when do you perform pneumatic otoscopy?

A

diagnosis of OME

child w otalgia, hearing loss, or both

41
Q

when do you do tympanometry?

A

suspected OME when diagnosis is uncertain after performing/attempting pneumatic otoscopy

42
Q

when do you do a hearing test?

A

OME persists >3 mo
OR
OME of any duration in an at risk child

43
Q

what are factors accounted for in surgical candidacy for OME

A

hearing status
associated symptoms
developmental risk
anticipated chance of timely spontaneous resolution of effusion