ENT - Otitis media

Question 1

what are the two different diagnoses for acute otitis media?

Answer 1

• AOM: acute inflammatory disease of middle ear and tympanic membrane with or without purulent middle ear fluid
• OME: presence of middle ear effusion without any local or systemic signs of inflammation

Question 2

what are the signs and symptoms of AOM?

Answer 2

• rapid onset
• bulging / fullness of TM
• redness of TM
• perforation of membranes with drainage
• ear pain, irritability, fever

Question 3

“middle ear effusion without signs or symptoms of inflammation”

Answer 3

otitis media with effusion

Question 4

what is the key factor regarding long term consequences of middle ear infections, including hearing loss?

Answer 4

duration of disease

Question 5

what is the pathophysiology of otitis media?

Answer 5

• preceding viral illness
• immature immune system
• auditory tube dysfunction

Question 6

what variable are responsible for declining expression of otitis media in the developing world?

Answer 6

immunization is changing:

• presentation
• complexity or virulence at presentation
• bacteriology

Question 7

what are the absolute contraindications to observing otitis media vs treating it?

Answer 7

• age under 6 months
• immune deficiency disorder
• severe illness or previous treatment failure
• inability to ensure follow up

Question 8

what are the relative contraindications to observing otitis media vs treating it?

Answer 8

• relapse within 30 days
• otorrhea
• bilateral otitis media if less than 2 years of age
• syndrome such as craniofacial malformation

Question 9

what is the first line abx for otitis media? severe otitis media?

Answer 9

• amoxicillin

- amoxicillin plus clavulanate

Question 10

what is the first line abx for otitis media with PCN allergy?

Answer 10

ceph

Question 11

what is the first line abx for otitis media with PCN AND ceph allergy?

Answer 11

macrolides

Question 12

when should children be reevaluated for failure of otitis media abx?

Answer 12

48-72 hours

Question 13

can steroids be used for otitis media?

Answer 13

NO

Question 14

what are the complications of otitis media?

Answer 14

• TM perforation
• chronic otorrhea
• chronic otomastoiditis
• cholesteatoma
• hearing loss

Question 15

what are signs that otitis media is no longer simply a difficult ear infection?

Answer 15

one or more of:

• persistent low intensity pain greater than 1 wk duration
• foul smelling persistent otorrhea
• retroorbital pain
• facial nerve paralysis
• vertigo

Question 16

what type of organisms are associated with mastoiditis with abscess?

Answer 16

anaerobic

Question 17

what is the most common organism associated with meningitis?

Answer 17

strep pneumo in acute otitis media

Question 18

what are the most common organisms associated with cholesteatoma?

Answer 18

pseudomonas and bacteroides