Mgmt of AOM in kids six months of age and older Flashcards
1
Q
Who is excluded from this statement?
A
- Kids under six months of age
- Immunocompromised
- Craniofacial anomalies
- Recurrent AOM
- Tympanostomy tubes
2
Q
What is the pathogenesis of AOM?
A
- Normally mucociliary clearance mechanisms ventilate and drain fluid from middle ear
- Mucosal inflammation impairs this and causes fluid stasis
- If fluid colonized with bacteria/viruses, get AOM
3
Q
List risk factors for AOM
A
- Young age
- Frequent contact with other kids (increased viral exposure)
- Orofacial anomalies (cleft palate)
- Crowded housing
- Cigarette smoke
- Pacifier use
- Decreased duration of breastfeeding
- Prolonged bottle feeding while laying down
- FHx AOM
- First nations or Inuit ethnicity
- Decreased secretory IgA or biofilms present in middle ear
4
Q
What are the most likely causes of spontaneously resolving AOM?
A
- Viral infection
- Moraxella Catarrhalis
- Hemophilus influenzae
5
Q
What bugs most commonly cause AOM?
A
- Strep pneumoniae
- Moraxella catarrhalis
- Hemophilus influenzae
- GAS (less common)
6
Q
Why is accurate dx of AOM critical?
A
- Overdiagnosis leads to side effects of antibiotics and colonization with drug resistant bugs
- Failure to eradicate bugs in cases of bacterial AOM increase risk for relapse
7
Q
What are systemic symptoms of AOM?
A
- Poor sleep, decreased energy, fever: all non specific
- Otalgia: also non specific
- Progressively/severely ill child more likely to have a bacterial process and lower chance of spontaneous resolution
8
Q
List characteristics of middle ear effusion
A
- Decreased mobility of TM when positive and negative pressure applied with pneumatic otoscope
- Loss of bony landmarks
- Air fluid levels
- Erythema or yellow coloration of TM
- Retraction or bulging (depending on chronicity)
9
Q
What are diagnostic criteria for AOM?
A
- Acute onset of otalgia with middle ear effusion and significant middle ear inflammation
10
Q
What proportion of non severe AOM will spontaneously resolve?
A
- 2/3
- More slow resolution than kids who get antibiotics
11
Q
What otoscopy findings are consistent with bacterial AOM?
A
- Bulging TM most sensitive and specific finding
- Acute perforation with prurulent discharge: seen more commonly with GAS
12
Q
What clinical features are not consistent with AOM?
A
- TM with normal or slightly decreased mobility
- Non bulging TM with or without erythema/cloudiness
- AF levels alone with no bulging not predictive of AOM
13
Q
List complications of AOM
A
- Acute mastoiditis (MOST COMMON)
- Facial nerve palsy d/t inflammation of temporal bone
- 6th CN palsy d/t inflammation of petrous bone
- Labyrinthitis d/t spread of infection to cochlear space
- Venous sinus thrombosis of transverse/lateral/sigmoid venous sinuses
- Meningitis
14
Q
Who can be managed with watchful waiting?
A
- Mild-moderate bulging TM
- Low grade fever
- Mildly ill, alert, responsive to antipyretics and analgesics
15
Q
Who needs antibiotics now?
A
- All kids with perforated TM
- Bulging TM
- Highly febrile T > 39
- Mod-severe systemic illness
- Sick for > 48 hours
- Severe otalgia
