Ears

Question 1

Epidemiology of acute otitis media

Answer 1

6-18 months

80% of children experience at least one episode of AOM before 2

Question 2

Aetiology of AOM

Answer 2

Respiratory viruses
Strep pneumoniae
H influenzae
Mortadella catarrhalis

Question 3

Pathophysiology of AOM

Answer 3

Spread of upper respiratory viral infection to Eustachian tube and middle ear cavity
Inflammation and impaired mucociliary function of Eustachian tube
Development of middle ear effusion
Can lead to secondary bacterial infection
Suppuration and pressure against TM - pain, fever
TM perforation
Mastoiditis - spread of infection to mastoid air cells

Question 4

Clinical features of AOM

Answer 4

Otalgia 
Irritability 
Sleep disturbance
Fever 
Preceding upper respiratory symptoms 
Bulging tympanic membrane 
Erythema of tympanic membrane

Question 5

Diagnostic criteria for AOM

Answer 5

Moderate to severe bulging of tympanic membrane OR

Mild bulging of tympanic membrane AND recent onset ear pain or intense erythema of tympanic membrane

Question 6

Management of AOM

Answer 6

Analgesia - paracetamol, ibuprofen

If suspected AOM:
Delayed Abx - Observation 2-3 days

Confirmed AOM:
<2 yo with bilateral AOM or severe bulging
Amoxicillin PO 10 days
Clavunalate

Tympanocentesis: If unresponsive to abx or require immediate pain relief

Question 7

Complications of AOM

Answer 7

Otitis media with effusion - persistent middle ear fluid
Bullous myringitis - bullae develops on tympanic membrane
Perforation of tympanic membrane
Mastoiditis - spread of bacterial otitis media to mastoid air cells