Disorders of the ME: ET, Otitis Media and Infection Control Flashcards
What is Otitis media?
Infection/inflammation of the middle ear
What are the 3 MOSTS of OM?
- Most common infection in childhood
- Most common reason for pediatrician visits
- Most common reason for antibiotic use
Responsible for development of antibiotic-resistant bacteria
What is the peak incidence of OM between 6-18 months old? (2)
- 50% of children by age of 1 yr
- By 3 yrs >85% of children have had 1 episode
What is AOM?
Acute (Severe) otitis media
What is OME? (2)
- Otitis media with effusion (fluid)
- Chronic (persistent) OME
What is CSOM?
Chronic suppurative otitis media
Describe Acute Otitis Media.
Infected middle ear fluid and inflammation of the mucosa lining the middle ear space (fever, pain, red and bulging TM)
Describe Otitis Media with Effusion: (2)
- Middle ear effusion without symptoms and signs of inflammation
- Equivalent terms: secretory OM, chronic serous OM, glue ear
Describe Chronic Suppurative Otitis Media:
Chronic purulent otorrhea through a permanent TM perforation or due to cholesteatoma (covered later)
What is the time frame for otitis to be considered Acute?
< 3 weeks
What is the time frame for otitis to be considered Subacute?
- 3 weeks to 3 months
What is the time frame for otitis to be considered Chronic?
> 3 months
What is the Eustachian Tube? (3)
- Connects middle ear to nasopharynx
- Bony and cartilaginous portions
- Ciliated respiratory epithelium (like nasal cavity)
What are the muscles important for the proper functioning of the Eustachian tube (3)
-Levator veli palatini
- Tensor veli palatini (dilator tubae)
- (Salpingopharyngeus)
What mouth condition disrupts the functioning of the muscles of the ET?
Cleft palate disrupts functioning of these muscles
Is the ET most of the time open or closed?
Usually closed
When does the Et open?
During swallowing and yawning
Which portions involved in the opening of the ET?
The opening involves cartilaginous portion and normal palatal muscle function
What are the functions of the ET? (3)
1) Pressure regulation of middle ear
Due to intermittent opening
2) Protection from nasopharyngeal sounds and secretions
3) Clearance of middle ear secretions
Mucociliary lining
What are the 5 pathophysiologies complications OM?
1) Upper respiratory infection
2) Inflammation of nose and eustachian tube
3) Eustachian tube dysfunction/obstruction
4) Negative middle ear pressure
5) Middle ear secretions
What do the ET children look like? (4)
1) Longer bony portion, shorter cartilaginous portion
2) 10 degree angle from horizontal
3) Small nasopharyngeal orifice in infants (4-5 mm)
4) Less mature muscles
What do the ET Adults look like? (4)
1) Anterior 2/3 cartilage, posterior 1/3 bony
2) 45 degree angle from horizontal
3) Large nasopharyngeal orifice (8-9 mm)
4) More mature muscles
What could occur if ET does not open normally? (2)
Eustachian tube dysfunction (ETD)
Otitis media
What could occur if ET opens too easily?
Patulous Eustachian tube: a disorder of the valve of the Eustachian tube that causes it to remain open.
What do Acute Otitis Media present with? (3)
- Upper respiratory infection (URI) features
Cold symptoms - Local
Otalgia, otorrhea, hearing loss, “ear tugging” - Systemic
Fever, malaise, irritability
What is Ear Tugging?
Child pulls on their ear
Primary sign of Acute Otitis Media
0% had OM (study with hundreds of children)
With fever
15% had OM (similar study)
Which bacteria typically cause AOM?
Streptococcus pneumoniae - Left (a frequent cause of OM)
Haemophilus influenzae - Middle
Moraxella catarrhalis - Right
What often precedes Acute Otitis Media?
Viral Infections (Virus)
e.g.,
Rhinovirus
RSV
Influenza
Adenovirus
Parainfluenza
What is the peak incidence of AOM during a human’s year of life?
Peak incidence in first 2-3 years of life; and more males than females
What are the multiple factors that cause a peak incidence of OM in the first 2-3 years of life? Give 3
Daycare
First nations
Winter months
Bottle feeding
Smoke exposure
Lower socioeconomic status
What are the physical risk Factors that can cause AOM? (Give 3)
Allergies
Craniofacial disorders (including cleft palate)
Immune deficiency
Reflux disease
Nasal obstruction (eg adenoid hypertrophy)
Are vaccines effective against AOM?
Yes, very effective against severe infections!
Streptococcus pneumoniae is a frequent cause of OM
What causes Otitis Media with Effusion?
Fluid in middle ear space
No clinical features of acute inflammation/infection
Does OME usually present symptoms?
Usually asymptomatic
With what sensations OME can be associated with? (3)
- Pressure or fullness sensation, ear popping
- CHL
- Recurrent AOMs
What are the 3 Types of middle ear effusions?
Mucoid (thick, glue-like)
Serous (thin, watery, bubbles)
Purulent (thick, pus)
In which of the 3 types of Otitis media is Purulent Effusion seen? (2)
AOM and CSOM
What is the treatment for OME?
Most of the time NO treatment is necessary
Often self-limiting
How can OME affect children? (3)
It can cause hearing loss in children, possible language delay, and school performance issues
What does this graph show?
Most of the time NO treatment is necessary and over time heals itself 90% of the time
What are the long-term effects of OME? (2)
Mixed results on the development of cognitive, linguistic, auditive, and communicative skills
Severe hearing loss can produce severe impairments, however less agreement that mild hearing loss produces impairments
What is a surgical treatment for OME if needed?
Tympanostomy tubes then follow-up audiograms
What is a treatment for not-at-risk children?
- Watchful waiting for 3 months of onset (if known) or 3 months from diagnosis
- Hearing test if persistent for 3 months or if significant hearing loss, language delay, or learning problems
Re-examine every 3-6 months
What is the link between Otitis media and the mastoid bone?
- The middle ear is connected to the mastoid bone
- Fluid in middle ear space -> fluid in mastoid
- On the CT scan, it shows opacification of ME and Mastoid
What are the ways to help diagnose OM?
*Clinical history
*Otoscopy (pneumatic)
*Audiogram
-Hearing status (CHL)
- Tympanometry
-Compliance of tympanic membrane
What is pneumatic otoscopy?
- Pneumatic attachment blows air onto TM
- Assess color, position and mobility of TM
What does this picture show?
It shows TM normal mobility when a puff of air is sent through the ear canal using Pneumatic Otoscopy
What does this image show?
Using pneumatic Otoscopy shows a reduced mobility of TM due to AOM.
What does this image show?
Using pneumatic Otoscopy shows reduced mobility of TM due to OME.
How does Tympanometry work? (3)
3 parts of the probe
- Manometer (pump) varies air pressure against TM and changes ear canal pressure and measures it
- Speaker produces a 220Hz probe pure tone
- Microphone measures loudness of sound in ear canal which depends on how much is reflected back
Why do we use ear tubes? (2)
We do a Myringotomy-incision in the TM to:
Pressure equalization
Middle ear fluid exit
What is the most common surgical procedure in North America?
Ear Tubes surgery
What are other names for Ear Tubes? (4)
Tympanostomy tubes
Ventilation tubes
Pressure equalization tubes
Grommets
What is occurring in this picture?
Severe TM retraction due to too much negative pressure in the ME
What are the complications of Ear Tubes? (Give 3)
- Tympanosclerosis/myringosclerosis
- Perforation (after tube falls out)
- Tube otorrhea
- Tube blockage
- Granulation tissue
- Cholesteatoma
What is occurring in this image?
OM with Ear Tubes
What is occurring in the image?
Chronic OM with Ear Tubes/Tube associated granulation tissue (friable, bleeding tissue)
What occurs in this image?
Using pneumatic Otoscopy shows absent mobility of TM due to TM perforation or ear tube.
What are the intracranial complications of OM? (4)
- Meningitis
- Brain abscess (extradural subdural, cerebral)
- Sigmoid sinus thrombosis
- Otitic hydrocephalus
What are the extracranial complications of OM? (Give 3)
Mastoiditis
Bezold’s abscess
Petrous apicitis
Facial Paralysis
TM Perforation
Hearing loss
Labyrinthitis
What is Mastoiditis? (2)
- AOM and local inflammatory findings over the mastoid bone
What are the symptoms of Mastoiditis? (5)
Pain, erythema, tenderness, swelling/auricular protrusion
Into what other complications can mastoiditis develop? (3)
Bezold’s abscess, meningitis, sigmoid sinus thrombosis
What are treatments for Mastoiditis? (2)
- IV antibiotics
- Tubes +/- mastoidectomy
What is Bezold’s Abscess?
- Spread of infection from mastoid tip to the upper neck
- Presents with AOM and upper neck mass
What are treatments for Bezold’s Abscess? (3)
- IV antibiotics
- Mastoidectomy
- Drainage of abscess
What is Petrous Apicitis?
Inflammation of the petrous apex portion of the temporal bone
What conditions can Petrous Apicitis cause? (4)
- Gradenigo’s triad
- Retroorbital pain
- Otorrhea
- CN6 palsy
What are treatments for Petrous Apicitis?
IV antibiotics,
Bone drill out
What is Facial nerve paralysis? (3)
- Usually seen with AOM in children
- Possible dehiscent facial nerve in middle ear space
- Good resolution rates
What are treatments for AOM of patients with Facial nerve paralysis? (3)
IV antibiotics
Ear tube
Ototopical drops
What is Labyrinthitis?
Inflammation of labyrinth
AOM spreads through weak or dehiscent oval window
Severe auditory and vestibular loss occurs
Nystagmus, tinnitus, hearing loss and vertigo all appear promptly
What is a treatment for labyrinthitis?
Treatment is IV antibiotics but function may not recover
What is a treatment for labyrinthitis?
Treatment is IV antibiotics but function may not recover
What is Meningitis?
- Inflammation of the meninges (lining of the brain)
- Dramatically reduced due to vaccination
- Headache, photophobia, fever, decreased level of consciousness, neck rigidity
- Diagnosis: CT and LP
- Management: IV antibiotics (+/- tubes)
- Follow-up audio crucial (late-onset SNHL)
What is a brain abscess?
A localized collection of pus
Spread from mastoid/middle ear via venous channels
Focal neurologic signs and headaches
What is Sigmoid Sinus Thrombosis?
- The sigmoid sinus (large draining vein) is located just posterior to mastoid
- Thrombosis = stationary blood clot but can spread to other areas
- Signs of mastoiditis, severe headaches septicemia, picket-fence spiking fevers
What is a treatment for Sigmoid Sinus Thrombosis? (3)
IV antibiotics
Mastoidectomy
Anticoagulation
What is Otitic Hydrocephalus?
Too much CSF
Increased intracranial pressure (ICP)
Results from AOM and thrombosis
Progressive headache
If collateral drainage inadequate, can progress to coma, death
Treatment: reduce ICP (neurosurgery)
What are the most common bacteria found on hearing aids?
Staphylococcus
