Exam 1 - Otitis media Flashcards
Is acute otitis media more common in adults or children?
Common in children <5 years
- Due to position of eustacian tube (more horizontal and narrow)
What organisms cause AOM?
Can be caused by bacteria and viruses
- S. pneumo, h. influenzae, moraxella catarrhalis, s. pyogenes
AOM risk factors
- URI
- Allergies
- Cleft palate
- Adenoid hypertrophy
- Tobacco exposure
AOM symptoms
Worse when lying down
- Ear pain
- Ear pulling (infant/toddler)
- Fever
- Otorrhea
Diagnostic findings of AOM
- Recent onset middle ear inflammation and effusion
- Bulging TM, decreased mobility, air fluid level
- Otorrhea
- TM erythema and pain
True/false: redness of TM should not be used alone to diagnose AOM
True - redness can occur as result of fever or child crying
What tool would be helpful in diagnosing AOM?
Pneumatic otoscope - will demonstrate decreased TM mobility
Mild versus severe AOM: temperature and time of onset difference
Mild: temperature <39 C, symptoms occur <48 hours
Severe: temperature >39 C, symptoms occur >48 hours
How would the provider manage pain associated with AOM?
- Heat or cold compresses
- Distraction
- Acetaminophen or ibuprofen in children >6 months
When is antibiotic therapy warranted for children with AOM?
- <6 months or any age with underlying condition
- Children more than six months old with severe signs; otalgia for >48 hours
- 6-23 months old with mild or severe bilateral AOM
For which patients would the provider observe with close follow up instead of starting antibiotic therapy?
6-23 months old with non-severe unilateral AOM and any child >24 months with non-severe bilateral or unilateral AOM
What medication is considered first line for AOM treatment (both adults and children)?
Amoxicillin
What is the alternative to amoxicillin if patients cannot take that for AOM?
Amoxicillin-clavulanate is next in line if amoxicillin taken in past 30 days or if the patient also has conjunctivitis
What medication can be prescribed if a patient has a PCN allergy when determining treatment for AOM?
Cephalosporin - if non-type 1 hypersensitivity reaction to PCN
- Cefdinir, cefuroxime, cefpodoxime, ceftriaxone
What is the usual dose of antibiotic therapy when treating AOM?
If <2 years old, treat for 10 days
If >2 years old, treat for 5-7 days
Can smoking cessation and getting a flu shot prevent AOM?
Yes - improvement should be seen in 3 days
AOM complications: mastoiditis
- Symptoms
- Fever
- Pain in ear
- Swelling posterior to ear and right over mastoid process
Does mastoiditis require emergency care?
Yes - requires urgent ENT referral
AOM complications: perforation
- Symptoms
- Treatment
Severe pain that suddenly disappears with perforation, otorrhea
Treatment: otic drops (ciprofloxacin), oral antibiotics
AOM complications: perforation
- Management
Heals within a few weeks, but requires close follow up
- Should not allow water to get into ear
AOM complications: AOM with effusion
- Symptoms
Does not cause pain, but causes feelings of pressure
- If symptoms persist longer than 3 months, refer for hearing testing
What should the provider do if a patient has hearing loss after an AOM effusion?
Consider inserting a t-tube and ENT referral
AOM complications: cholesteatoma
- What is this?
Epidermal inclusion cyst of middle ear
Pearly white lesion on TM
AOM complications: cholesteatoma
- Symptoms
May have hearing loss, vertigo, but can be asymptomatic
- Referral to ENT
What is acute otitis externa?
Aka “swimmers ear”
- Inflammation of external ear canal due to moisture in ear thus allowing bacterial growth
Acute otitis externa symptoms
- Pain
- Hurts when ear is touched (tender when tragus or auricle is palpated)
- Drainage
- Itching
- Fullness
- Hearing loss
- Edema, erythema in ear canal
Acute otitis external risk factors
Putting foreign bodies in ear (earbuds, q tips)
When should the provider consider cause of ear pain to be fungal?
Consider fungal infection if treatment of AOM with antibiotics doesn’t work
Acute otitis externa differential diagnosis
- AOM
- TMJ (pain can refer to jaw)
- Fungal infection
Acute otitis external treatment
Uncomplicated - topical antibiotic ear drops (improves in 5-7 days)
Acute otitis externa patient education
- Ear wax has protective function (don’t clean with q tips)
- Keep ear dry, avoid swimming or submerging head until infection is cleared
- Use hair dryer when coming out of pool or shower
