ENT Flashcards
Diagnosis of Otitis media
acute onset, abornmal ear exam eg middle ear effusion and inflammation
Peak age for otitis media
6-18 months
Modifiable risk factors for Otitis media
Cigarette smoke
Clinical course of otitis media
Recent onset of ear pain usually 1-2 days after URTI Fever loss of appetite vomiting lethargy cochlear implant immunocompromised high risk population may be asymptomatic Self resolved in 80% after 2-3 day but symptoms may persist for up to 8 days
Examination finding for acute otitis media
bulging, red, opaque TM, Fever
non mobile TM
examination finding for otitis media with effusion
TM is retracted with prominence of the handle of the malleus, which is also drawn in/more horizontal
TM may be bulging or have an air-fluid level behind the TM
Yellow/amber appearance is consistent with fluid
Light reflex on otoscopic examination
Mx of AOM
Education share management model simple analgesia If severe acute ear pain then topical analgesia 2% lidocaine to intact TM by skilled person Review in 24 yr for <2 yr review in 48 hr in >2 yr
High risk features who need antibiotics
Infants <6 months
Children <2yr with bilateral infection
Children who are systemically unwell eg lethargic, pale, very irritable,. Fever alone is not one.
Children with otorrhoea
Aboriginal and torres strait islander children
Children at high risk of complications eg immunocompromised children
Antibiotics indicated for AOM if
perforation
high risk with chronic suppurative otitis media
Harm of antibiotics
Benefit 2 -3 out of 100 - no improvement to pain. Shorten course by 12 hr
Harm: 7 out of 100
Harm - Diarrhoea, rash, Hypersensitivity or resistance.
Antibiotics for AOM
Amoxicillin 15mg/Kg up to 500mg 8 hourly for 5 days
If adherence to 8hour regimen unlikely then 12 hourly regimen can be used. Amoxicillin 30mg/kg up to 1 g orally 12 hourly for 5 days
If not improving at 48-72 hr Amoxicillin + clavulanate 22.5+3.2mg/kg up to 875+125mg orally 12 hourly for 5-7 days
If chronic otorrhoea add in ciprofloxacin 0.3% ear drops, 5 drops to affected ear 12 hourly until middle ear free of discharge for at least 3 days
Delayed nonsecure hypersensitivity to penicillins
Cefuroxime (>3months old) 15mg/kg up to 500mg orally 12 hourly for 5 days
Or Trimethoprim +suflamethoxazole (>1 months) 4+20mg/kg up to 160+800mg orally, 12 hourly for 5days
Immediate (nonsecure or severe) or delayed severe hypersensitivity to penicillins use Trimethoprim +sulfamethoxazole
Complication of AOM
TM perforation Acute mastoiditis Intracranial spread of infection eg meningitis or abscess Lateral sinus thrombosis facial nerve palsy atelectasis of TM cholesteatoma Otitis media with effusion Chronic suppurative otitis media
Risk factors Recurrent bacterial Otitis media
group child care
Allergic rhinitis
Adenoid disease
Various structural anomalies, such as cleft palate and those associated with down syndrome
Exposure to smoke eg cigarettes, wood fires
Socioeconomic disadvantage eg crowded housing
when is prophylaxis for recurrent otitis media indicated
Antibiotic prevention of acute otitis media is indicated (arguably) if it occurs more often than every other month or for three or more episodes in 6 months or >4 in 12 months:14
chemoprophylaxis (for about 4 months)
amoxycillin twice daily (first choice) or
cefaclor twice daily
consider referral if 3 or more episodes in 6 months
when to refer for otitis media with effusion
Elective referral
Middle ear effusion for 3months or more with associated symptoms of hearing loss or speech and language delay
Hearing loss >30dB with symptoms of speech delay, educational impairment or behavioural symptoms
Significant retraction pocket in tympanic membrane
