Middle Ear Disorders - OME Flashcards
what is otitis media (w/ effusion)
infectious inflammation of the ME that results in accumulation of fluid (effusion) in ME cavity
why is acute myringitis often misdiagnosed as acute OM
redness of TM without effusion
what can cause rednss of tm without underlying effusion/infection that can be mistaken for OM
Excessive blowing of the nose/crying especially in younger children,
what is the historical disorder reported in egyption mummies
TM perforations and mastoid bone destruction
OME
what type of tymp could you see in OME
most likely will see type b with fluid in there
type c tymp - could be if it is in the beginning process (neg pressure)
as the child grows older the number tht has OME goes_____
down
the younger the child the more they _____ OME
have
second only to viral infections of upper respiratory tract as the most common reason for visits to the pediatrician
OME in children
An epidemiologic study by the University of Pittsburgh revealed an incidence of ______for OM for children in urban areas within the first 2 years of life
90%
what age group do we see more OME
1 yr to before school age
with a child who has a risk of upper respiratory infection why does it risk OME?
because ET is opened to the nasopharynx and is surrounded by soft muscles and with inflammation of upper respiratory, these muscles swell and it closes off opening of ET, hard for it to drain
connection to the back of throat to the middle ear
what race is more common OM and the less common
caucasians, asians and blacks
higher incidence of OM in ___ than ____
males, females
what is peak incidence of OME
October and April; incidence declines during the summer months
Greater incidence in children with a history of upper respiratory illness such as
colds, asthma, and allergies
children outgrow susceptibility to OM by ______ years of age as the ET assumes adult proportions
6-8
Three factors facilitate bacterial reflux in the ME
Incompetence of the protective function of the ET
Negative pressure in the ME in relation to the nasopharynx
Bacterial colonization of the nasopharynx
what are the etiologies of OM
bacterial and viral
what are bacterial etiologies of OM
most commonly found in upper respiratory tract infections
Streptococcus pneumoniae
Hemophilus influenzae
what are viral etiologies of OM
Respiratory syncytial virus – most common (RSV
Rhinovirus
Parainfluenza virus
Influenza virus
what are the 3 criteria set by amerian academy of pediatrics and american academy of family physicians for acute otitis media diagnosis
acute onset
ME inflammation
ME effusion (ME fluid buildup
what is acute otitis media (AOM)
Short-term (< 3 weeks), a self-limiting condition
what ar ethe two types of AOM
severe & non severe
describe severe AOM
Moderate to severe otalgia and temperature > 1020F (39°C)
describe non severe AOM
Mild otalgia and temperature < 1020F (39°C)
what is often over diagnosed
AOM
what are the 3 stages of AOM
hyperemic stage
aom with effusion
aom with supperative stage
what are the classifictions of om basaed on duration
sub acute
recurrnt
chronic
what is sub acute om
condition persisting for 3 weeks to 3 months
what is recurrent om
Multiple self-limiting episodes with symptom-free periods between flare-ups
3 or more episodes w/in 6 mo period
OR 4 or more episodes
what is chronic om
Condition persisting for > 3 months (> 30 days-Text)
Generally with effusion but without other signs of inflammation i.e., fever or otalgia
what is me effusion
almost always follows AOM and can take 2 to 3 weeks to clear post treatment/recovery
describe persistent mee
Effusion can persist for an average of 40 days
High incidence of persistent MEE in children
children <2 yrs are more likely to have persistent MEE
Higher incidence of persistent MEE for Caucasian children
Serous effusion can occur without OM such as in cases of
barotrauma
what is barotrauma
a lot of divers
sudden change of pressure
seasonal allergies
airplane trips
hwen do you recommend they come back and follow up and give antibiotics for 7 days?
2-3weeks to make sure the fluid has been absorbed
om classification based on fluid
Serous OM (SOM - clear)
Mucoid OM (MOM - thick and colored)
Purulent OM (POM - odorous and thick)
“Glue ear”
Serous OM (SOM -
clear fluid, not infected
why are infants being breast fed less likely to be affected?
antibodies that go through placenta and when theyy are born, breast feeding, immunogobulins are delivered to baby through the breast milk
immune system is building in first 3 months of life
Mucoid OM (MOM
pussy, coloredv= infection because it is pussy (yellow, green, etc.)
thick and colored
Purulent OM (POM
odorous and thick
what is glue ear
used to describe chronic mucoiud OM
If chronic low grade ME infection persists due to chronic ET dysfunction it will lead to the ME cavity filling with gelatinous inflammatory exudate/cellular debris - the “glue” of glue ear
This process may lead to retraction of the TM and ultimately formation of retraction pockets and bone erosion
self limiting in most cases
what are risk factors for OME
age (peak bw 6-11 mos)
ET dysfunction
craniogacial anomalies (increased with cleft lip/palate and down’s)
decreased risk for breast fed
day care attendance
usceptibility to upper respiratory tract infections (URTI)/allergies
Smoking in the home including second-hand smoke
Family history of OME
Male
Low birth weight (< 1500 grams or 3.3 lbs)
Socio-economic status (SES): Inverse relationship between SES and OME probably because of lack of access to health care, poor diet and overcrowding
what are symptoms of OME
Otalgia
Fever
otalgia & fever an be absent in older children
Erythema (redness) of the TM
Effusion in the ME
Irritability/fussiness
May not want to eat
Inconsistent responses to sound
Delayed speech and language development
Reduced attention span especially in the classroom
what could OME otososcopy look like
Discolored/red TM
Opacification of normally lustrous TM
Partial/complete bulging of TM with obliteration of malleolar handle
Retracted TM
Perforation of TM
Fluid line or bubbles observe in the middle ear
what is opacification
blurring/spreading of the cone of light
what could you see for immitance results on OM
Flat (Type B) tympanogram
Negative pressure >200 daPa (Type C) tympanogram
Flat high volume (Type B - high volume) tympanogram consistent with TM perforation
Inability to get a hermetic seal (with perforation) in older equipment
Abnormal (elevated)/absent ARTs
what would you see for unilateral OM in ARTs
Typical only the ipsilateral ART will be present on the unaffected side
for bilateral OM what would you see in ARTs
Ipsilateral and contralateral ARTs will be abnormal for both ears
children ECV
around 1 to 1.2 ml
what pure tone results could you see
w/in normal limits (</= 20dB HL)
may be abg exceeding 10 HL (conductive component)
fluctuating HL
chl not exceeding 60-65 dB
possible rising or reverse slope configuration of hearing loss
if you have a r om, what would l art look like
left ipsi would only be noral
contra would need to be elevated/abs in order for it to cros over to the unaffected side
what speech audiometry results would we expect with OM
normal supras (WRS)
sr-pta are in good agreement
what is a rising configuration?
abnormal lf and rising to normal or close to normal hf hearing
what is a sloping configuration?
normal to near normal lf and hf abnormal hearing
normal to near normal lf and hf abnormal hearing
middle ear
what would you expect speech to be with CHL with om
srt and pta will be in agreement (both are threshold tests)
what is a max chl
if loss goes below this level, bone shifts as well (some involvement of a cochlear loss)
around 60-65dB after this it starts to effect bone and shifts to a mixed loss
what is the most common configuration for chl
rising
abg
low frequency loss
around 2-3000 becomes normal
do all chl look the same
many different patterns for middle ear pathology and om depending on severity of the condition
have to be aware of what to expect
many ways it can present itself
critical learnig language period
0-3
what are the consequences of OM
permanent/temporary chl
damage to me structures
cholesteatoma
permanent hf snhl
how can we get permanent hf snhl with om
Inner ear structures affected by passive diffusion or active transportation of toxins through round window membrane resulting in a permanent SNHL
what damage to middle ear structures do we see with om
can lead to ossicular destruction and conductive hearing loss, common with “glue ear”
Release of inflammatory mediators in ME space and release of specific enzymes, such as collagenase, a tissue destructive protease, that can lead to ossicular destruction and conductive hearing loss, common with “glue ear
why do we see cholesteatoma in om
what higher order auditory fxn do we see ome
auditory deprivation that can affect language development
binaural auditory processing deficits
difficulty discriminating speech sounds (ta vs da)
issues w/ initial and final voiced/voiceless plosives (b vs p)
issues attending to auditory input (learned inattentioin)
OME consequences
Higher order auditory function
Known long-term implications
Structural changes
long term implications of ome
attention deficit through adulthood
s/l delays (esl who have ome are at greater risk)
academic failure
behavioral issues
risk factor for CAPD
structural changes due to ome
altered abr recordings after ome resolution during pre adolescent years
alteration of acoustic-immittance characteristics of me system - larger tymp widthy, shallow admittance, elevated arts
thickened mucous that adheres to the ossicles and adheres them to the mastoid
glue ear
what is the pseudotumor
not a real tumor, but it acts like a tumor
grows rapidly and very invasive
w/ chronic/untreated OME or chronic - ve ME pressure
cholesteatoma
most common reason for visit to pediatricians
om
what are some societal consequences of om
annual expenditure is around $3.5 billion
most common pedistrician visit
time off work, & school (lossof productivity)
tymp tube placement is 2nd most common surgical procedure in children
development of multidrug resistant bacteria
2nd most common surgical procedure in children
Tympanostomy tube placement
what are sytpms of chronic ome
Can be asymptomatic
May have a hearing loss
May report feeling “plugged”
May report “popping” of ears
what are symptoms of acute om
Can follow upper respiratory tract infection
Fever
Otalgia
Hearing loss (temporary)
Otorrhea
May have associated systemic symptoms
Nausea
General malaise
Lack of appetite
what is the gold standard for diagnosing ome
pneumatic otoscopy
Standard otoscopy may be useful in visualizing
TM color
Opaque, yellowish red, red or pink
Position
Bulging or retracted TM (-ve pressure tympanogram)
Mobility
Normal, hypo-mobile, or retracted TM
Other findings
Discharge, perforations, cholesteatoma, or retraction pockets
audiologic diagnosis of OME
chl
mixed hl
snhl
flat type b (can have high volume)
type c neg pressure
abnormal gradient/width
abn/abs reflexes
what medictions are needed for OME (AOM)
antihistamine/decongestants
antibiotics
myringotomy
Resolution of condition occurs in 7 to 14 days for ____ of untreated children and _____ of treated children
81%
94%
____ can typically persist for > 2-3 weeks following antibiotic therapy and after resolution of the actual infection
Effusion
why are Prophylactic/prolonged antibiotics are contraindicated
because of an increase in antibiotic resistance
what is prophylcactic
prevention
why would management include Adenoidectomy and/or tonsillectomy
it decreases the need for repeated PE tube replacement
what are some compications from OM
acute mastoiditis
ossicular erosion (CHL)
SNHL (toxins going through round window)
facial n paralysis
labyrinthine fistula
meningitis
brain abscess
