First Aid, Chapter 7 Hypersensitivty Disorders, Otitis Media

Question 1

What is the definition of recurrent AOM?

Answer 1

> 3 episodes within 6 months or >4 episodes within 1 year with at least 1 episode in the past 6 months.

Question 2

What factor is protective against AOM?

Answer 2

breastfeeding

Question 3

Why are children younger than 3 at increased risk of AOM?

Answer 3

Lack of pneumococcal antibodies and the horizontal position of the eustachian tube interferes with drainage.

Question 4

What bacteria is more common in neonates to cause AOM?

Answer 4

group B strep

Question 5

What is the order of bacteria in AOM?

Answer 5

Traditionally, S. pneumoniae was more common. Since the introduction of pneumococcal vaccination, S. pneumoniae = H. influenzae, and M. catarrhalis is third

Question 6

What are viral causes of AOM?

Answer 6

RSV or rhinovirus.

Question 7

What bacteria is Conjunctivitis with otitis (otitis-conjunctivitis) most likely caused by? What antibiotic should be used?

Answer 7

Conjunctivitis with otitis (otitis-conjunctivitis) is more likely caused by nontypeable H. influenzae and suggests that a broader-spectrum antibiotic like amoxicillin-clavulanate may be indicated.

Question 8

When is AOM diagnosed?

Answer 8

• Moderate to severe bulging of the TM or new onset of otorrhea not due to acute otitis externa
• Mild bulging of TM and recent (

Question 9

What are treatment guidelines for AOM for a 6mo with unilateral or bilateral involvement w/ severe signs/symptoms? what are severe signs symptoms?

Answer 9

Treat × 10 days 
Symptoms:
-Moderate-to-severe otalgia 
-Otalgia for at least 48 hr 
-Fever >102.2oF

Question 10

What are treatment guidelines for AOM for 6-23 months of age for b/l involvement w/o severe signs symptoms (mild otalgia

Answer 10

Treat x 10d.

Question 11

What are treatment guidelines for AOM for 6-23 months of age for unilateral involvement w/o severe signs symptoms (mild otalgia

Answer 11

Joint decision making with parent(s)/caregiver regarding: -Treatment × 10 days or
-Observation with close follow-up

Question 12

What are treatment guidelines for AOM for >24 months of age with unilateral or bilateral involvement without severe signs/symptoms?

Answer 12

Joint decision making with parent(s)/caregiver regarding:

• Treat (2–5 years: 7 days; >6 years 5–7 days) or
• Observation with close follow-up

Question 13

What antibiotic should be prescribed for AOM in a pt who has received amoxicillin in the past 30 days or has concurrent purulent conjunctivitis?

Answer 13

amoxicillin/clavulanate

Question 14

How long should you give AOM to respond to abx before prescribing a different one?

Answer 14

48-72 hours

Question 15

Is bactrim recommended for AOM?

Answer 15

no, high resistance.

Question 16

What abx should be used in AOM with type I PCN allergy and negative testing/challenge to cephalosporins?

Answer 16

cefdinir, cefuroxime, cefpodoxime, or ceftriaxone

Question 17

What abx should be used in patients who fail treatment with augmentin?

Answer 17

cetriaxone for 3 days.

Question 18

What age does OME occur?

Answer 18

Most commonly, it occurs in children younger than 2 years of age, may occur in some children from 2–6 years of age, and very rarely occurs after the age of 6.

Question 19

What are the symptoms of OME?

Answer 19

Subtly decreased hearing and the sensation of fullness in the ear.

Question 20

How is OME diagnosed?

Answer 20

Pneumatic otoscopy is sensitive (nearly 90%), but not as specific (50–88%), whereas a tympanogram may be helpful for confirming uncertain cases or documenting hearing loss (Figure 7-1).

Question 21

What is a persistent OME in an adult concerning for?

Answer 21

Structural abnormality such as a tumor.

Question 22

What is the most common cause of OME?

Answer 22

Recent AOM w/ lingering ETD.

Question 23

Is there a link between atopy and OME?

Answer 23

Not enough evidence to suggest a causal link.

Question 24

Is there an increased risk of OME in atopic pts?

Answer 24

Yes, strong increased relative risk.

Question 25

How long with OME last after AOM?

Answer 25

After AOM, the majority will have an effusion at 2 weeks, nearly 50% at 1 month, 10–25% at 3 months, and 5–10% will last 1 year or longer.

Question 26

What is the leading hearing loss cause in children? What is the average hearing loss from this cause? What is it associated with?

Answer 26

OME, usually conductive. The average hearing loss from OME is 25 dB (mild = 21–39 dB loss; moderate ≥ 40 dB). It may be associated with language delay in children younger than 10 years of age.

Question 27

How often should children with OME be monitored? How should they be evaluated? Do medications help?

Answer 27

Examination 3 months after onset of OME with baseline hearing test; then serial evaluation every 3–6 months. These evaluations should continue until the effusion resolves, hearing loss is documented, or structural changes of the TM or middle ear are noted. Antihistamines, decongestants, antibiotics, or intranasal steroids have no proven benefit. Identify at-risk children (i.e., those at greater risk for developmental or language delay), who may require more aggressive management.

Question 28

What age children are at risk for language delay with OME?

Answer 28

Less than age 10.

Question 29

When is surgery indicated for OME? What surgeries are indicated?

Answer 29

structural damage, recurrent OME, hearing loss of 40 dB or higher, or hearing loss 21–39 dB in at-risk children. (Note: Both thresholds apply to the better ear.) Surgery may include myringotomy (incision of TM) with or without tympanostomy tubes, adenoidectomy, or both. Any repeat surgery should include an adenoidectomy, which results in improved eustachian tube drainage with less of a local nidus for infection.

Question 30

What are extracranial and intracranial complications of AOM?

Answer 30

Extracranial complications include:

• TM perforation
• Chronic AOM -Labyrinthitis or vestibular disturbance (secondary to fistula formation)
• Mastoiditis
• Facial paralysis
• Subperiosteal abscess

Intracranial complications of AOM include:

• Meningitis
• Brain abscess
• Sinus thrombosis
• Epidural abscess
• Subdural empyema

Question 31

What are OME complications?

Answer 31

Hearing loss, TM retraction, or cholesteatoma.

Question 32

What is a cholesteatoma?

Answer 32

A cholesteatoma is a destructive, expanding accumulation of keratinized squamous epithelium in the middle ear or mastoid which usually occurs as a result of chronic or recurrent infection.