Case 14: 18 mo old with congestion

Question 1

What are the most common bacterial causes of acute otitis media?

Answer 1

strep pneumo
HIB nontypeable
Moraxella catarrhalis
strep pyogenes

Question 2

What viruses are known to be particularly associated with acute otitis media?

Answer 2

RSV, influenza, rhinovirus

Question 3

AOM resolves spontaneously __% of the time without complications.

Answer 3

50-80%

Question 4

What is the number needed to treat for AOM?

Answer 4

7 to 20

Question 5

What are some risk factors for AOM?

Answer 5

daycare attendacne
tobacco exposure
allergies
bottle propping at bedtime
pacifier use
formula instead of breast
family hx of AOM
male gender
low socioeconomic status
respiratory allergies
onset of otitis in the first year of life

Question 6

True or false: ear effusions typically resolve quickly after the initiation of antibiotics.

Answer 6

false - last up to a month in 30-50% and 2 months in 15-25%

Question 7

What is the audiology test used in children ages 6 m o to 2.5 years?

Answer 7

visual reinforcement audiometry (measures baby’s response to both speech and frequency-specific stimuli presented through speakers and response to stimuli is rewarded by a three-dimensional toy)

conventional audiometry is not feasible until a child is about 4 yrs old and can follow instructions

Question 8

What is the first-line therapy for AOM?

Answer 8

amoxicillin

Question 9

If the AOM is associated with purulent conjunctivitis, what should you treat with?

Answer 9

Augmentin to cover for nontypeable HIB

Question 10

When should you definitely treat an AOM with antibiotics?

Answer 10

in a kid who is toxic-appearing, has persistent pain for 48 hrs or fever over 39 C in the past 48 hrs, or has bilateral AOM

Question 11

When should you strongly consider tympanostomy tubes?

Answer 11

persistence of middle ear fluid
conductive hearing loss
associated language delays