Mehl. UW. otitis media 02-28 (1)

Question 1

Mehl. OM. definition?

Answer 1

Infection of portion of ear just deep to tympanic membrane.

Question 2

Mehl. OM. Most common mo?

Answer 2

Strep. pneumonia

Question 3

Mehl. OM. CP?

Answer 3

Will present as red, IMMOBILE tympanic membrane.

Immobility of the tympanic membrane is highly sensitive for OM, meaning that if the Q says mobility is normal, we can rule out.

Question 4

Mehl. OM. “Ear tugging” can be a sign in children of either …..?

Answer 4

otitis media or externa.

Question 5

Mehl. OM. Tx?2

Answer 5

Tx is amoxicillin or penicillin.

Question 6

Mehl. OM. when give augmentin (amoxiclav)?

Answer 6

Augmentin (amoxicillin/clavulanate) is classically given for recurrent OM. So if you are forced to choose between amoxicillin/penicillin alone or Augmentin, go with the former.

Question 7

Mehl. OM. For 2CK Peds, a tympanostomy tube (aka grommet) is used if the kid has ….. how often OM?

Answer 7

> 3 OM occurrences in 6 months, or >4 in a year.

Question 8

Mehl. Serous otitis media. definition?

Answer 8

Aka otitis media with effusion.

Question 9

Mehl. Serous otitis media. CP?

Answer 9

Presents as fluid behind the tympanic membrane in a kid weeks after resolution of 1 or 2 otitis media infections.

Question 10

Mehl. Serous otitis media. Mx?

Answer 10

Almost always benign and self-resolves in 4-8 weeks. Answer is observation.

Question 11

UW. AOM table. Mos? 3

Answer 11

MCC - step. pneumonia
other: nontypable Haemophilus influenza
Moraxella catharalis

Question 12

UW. AOM table. CP?

Answer 12

Ear pain (eg irritability, poor sleep, poor feeding)
+/- fever

Question 13

UW. AOM table. Dx? 2 ways

Answer 13

Bulging TM
AND/OR
Middle ear effusion plus TM erythema [due to inflammation]

Question 14

UW. AOM table. Tx. 1st line?

Answer 14

amoxicillin

Question 15

UW. AOM table. Tx. 2nd line?

Answer 15

amoxiclav

Question 16

UW. AOM table. Tx. penicillin allergy?

Answer 16

azithromycin or clindamycin

Question 17

UW. AOM table. Complications? 4

Answer 17

TM perforation
conductive hearing loss
mastoiditis
meningitis

Question 18

UW. AOM. In what age common?

Answer 18

age < 5 y.o, because their eustachian tubes are straighter and narrower than in older children or adults AND tend to drain poorly.

Question 19

UW. AOM. classic presentation?

Answer 19

acute otalgia, fever, irritability

nonspecific for young children - irritability, poor sleep, decr. appetite

Question 20

UW. AOM. Tx is indicated for what age?

Answer 20

infants age < 6 months and children age >= 6 months with high fever, severe pain, bilateral disease.

buvo prie lentteles kad OBSERVATION can be considered for afebrile children age >= 6 months with unilateral disease and no/mild pain.

Question 21

UW. AOM. amoxicillin/amoxiclav is contraindicated if penicillin alergy

Answer 21

.

Question 22

UW. AOM. dar buvo parasyta kad amoxiclav in patients with resistant nontypable H. influenza, such as those with concomitant conjuctivitis.

Answer 22

.

Question 23

UW. AOM. why tmp-smx not suitable?

Answer 23

high rate of strep. resistance

Question 24

UW. AOM. why perforation? mechanism

Answer 24

increased middle ear pressure can cause localized ischemia and TM perforation, resulting in drainage of purulent material (ie otorrhea)

Question 25

UW. AOM. perforation can lead to what?

Answer 25

temporary conductive hearing loss, but TM typically heals spontaneously within days. Surgical correction may be required for perforation lasting several months.