ENT \ Earache Flashcards
What is acute otitis media (AOM)?
Middle ear inflammation associated with an infection
How is AOM thought to develop?
- Dysfunction and/or inflammation of the eustachian tube causes inadequate ventilation of the middle ear resulting in a negative pressure that pulls up fluid and infectious agents
Name the causes of eustachian tube dysfunction/inflammation
- URI
- allergies
- enlarged adenoids
- irritants (ie, tobacco smoke)
- genetic factors
What are the symptoms eustachian tub inflammation/dysfunction?
- Earache
- decreased hearing
- fever
- nausea
- vomiting
Why are symptoms alone not enough to make a diagnosis of AOM/ eustachian tube inflammation/dysfunction?
- There is no one symptom that is found reliably in all patients with AOM.
What does visualization of the tympanic membrane (TM) in AOM/eustachain tube inflammation/dysfunction reveal?
- Bulging
- red
- dull, or opaque TM
- displaced or absent light reflex
- loss of bony landmarks
- impaired TM mobility
What is the most important sign in the diagnosis of AOM or eustachian tube dysfunction?
- TM mobility (impaired)
Does an erythematous TM indicate AOM?
- Not necessarily. Increased intravascular pressure can also cause the TM to redden, such as when a child is crying.
What is the peak age of onset of AOM?
6 months to 7 years
What is the peak season of AOM?
Winter, because of increased upper respiratory infections
What are the most common bacterial causes of AOM?
- S. pneumoniae
- H. influenzae
- M. catarrhalis
What is the treatment for AOM?
Analgesic and antibiotic
What is the first-line antibiotic?
High-dose amoxicillin (for children, this means 70-90 mg/kg/day vs. standard 40 mg/kg/day)
Children under what age should be treated with antibiotics if AOM is suspected?
- Children under 6 months should always be treated.
- Children between 6 and 24 months should be treated with antibiotics unless the child has very mild disease.
What is the rationale for the “watch and wait” approach of AOM in children over 24 months?
While severe disease should always be treated with antibiotics immediately regardless of age, most AOM is not severe and will resolve spontaneously. Treatment only needs to consist of pain management. Almost every AOM is followed by otitis media with effusion (fluid in the middle ear).
