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AUDE 5410 Aud-Vestib Disorders > Middle Ear Disorders - OME > Flashcards

Middle Ear Disorders - OME Flashcards

1
Q

what is otitis media (w/ effusion)

A

infectious inflammation of the ME that results in accumulation of fluid (effusion) in ME cavity

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2
Q

why is acute myringitis often misdiagnosed as acute OM

A

redness of TM without effusion

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3
Q

what can cause rednss of tm without underlying effusion/infection that can be mistaken for OM

A

Excessive blowing of the nose/crying especially in younger children,

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4
Q

what is the historical disorder reported in egyption mummies

A

TM perforations and mastoid bone destruction
OME

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5
Q

what type of tymp could you see in OME

A

most likely will see type b with fluid in there
type c tymp - could be if it is in the beginning process (neg pressure)

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6
Q

as the child grows older the number tht has OME goes_____

A

down

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7
Q

the younger the child the more they _____ OME

A

have

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8
Q

second only to viral infections of upper respiratory tract as the most common reason for visits to the pediatrician

A

OME in children

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9
Q

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

A

90%

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10
Q

what age group do we see more OME

A

1 yr to before school age

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11
Q

with a child who has a risk of upper respiratory infection why does it risk OME?

A

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

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12
Q

what race is more common OM and the less common

A

caucasians, asians and blacks

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13
Q

higher incidence of OM in ___ than ____

A

males, females

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14
Q

what is peak incidence of OME

A

October and April; incidence declines during the summer months

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15
Q

Greater incidence in children with a history of upper respiratory illness such as

A

colds, asthma, and allergies

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16
Q

children outgrow susceptibility to OM by ______ years of age as the ET assumes adult proportions

A

6-8

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17
Q

Three factors facilitate bacterial reflux in the ME

A

Incompetence of the protective function of the ET
Negative pressure in the ME in relation to the nasopharynx
Bacterial colonization of the nasopharynx

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18
Q

what are the etiologies of OM

A

bacterial and viral

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19
Q

what are bacterial etiologies of OM

A

most commonly found in upper respiratory tract infections
Streptococcus pneumoniae
Hemophilus influenzae

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20
Q

what are viral etiologies of OM

A

Respiratory syncytial virus – most common (RSV
Rhinovirus
Parainfluenza virus
Influenza virus

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21
Q

what are the 3 criteria set by amerian academy of pediatrics and american academy of family physicians for acute otitis media diagnosis

A

acute onset
ME inflammation
ME effusion (ME fluid buildup

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22
Q

what is acute otitis media (AOM)

A

Short-term (< 3 weeks), a self-limiting condition

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23
Q

what ar ethe two types of AOM

A

severe & non severe

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24
Q

describe severe AOM

A

Moderate to severe otalgia and temperature > 1020F (39°C)

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25
Q

describe non severe AOM

A

Mild otalgia and temperature < 1020F (39°C)

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26
Q

what is often over diagnosed

A

AOM

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27
Q

what are the 3 stages of AOM

A

hyperemic stage
aom with effusion
aom with supperative stage

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28
Q

what are the classifictions of om basaed on duration

A

sub acute
recurrnt
chronic

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29
Q

what is sub acute om

A

condition persisting for 3 weeks to 3 months

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30
Q

what is recurrent om

A

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

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31
Q

what is chronic om

A

Condition persisting for > 3 months (> 30 days-Text)
Generally with effusion but without other signs of inflammation i.e., fever or otalgia

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32
Q

what is me effusion

A

almost always follows AOM and can take 2 to 3 weeks to clear post treatment/recovery

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33
Q

describe persistent mee

A

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

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34
Q

Serous effusion can occur without OM such as in cases of

A

barotrauma

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35
Q

what is barotrauma

A

a lot of divers
sudden change of pressure
seasonal allergies
airplane trips

36
Q

hwen do you recommend they come back and follow up and give antibiotics for 7 days?

A

2-3weeks to make sure the fluid has been absorbed

37
Q

om classification based on fluid

A

Serous OM (SOM - clear)
Mucoid OM (MOM - thick and colored)
Purulent OM (POM - odorous and thick)
“Glue ear”

38
Q

Serous OM (SOM -

A

clear fluid, not infected

39
Q

why are infants being breast fed less likely to be affected?

A

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

40
Q

Mucoid OM (MOM

A

pussy, coloredv= infection because it is pussy (yellow, green, etc.)
thick and colored

41
Q

Purulent OM (POM

A

odorous and thick

42
Q

what is glue ear

A

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

43
Q

what are risk factors for OME

A

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

44
Q

what are symptoms of OME

A

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

45
Q

what could OME otososcopy look like

A

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

46
Q

what is opacification

A

blurring/spreading of the cone of light

47
Q

what could you see for immitance results on OM

A

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

48
Q

what would you see for unilateral OM in ARTs

A

Typical only the ipsilateral ART will be present on the unaffected side

49
Q

for bilateral OM what would you see in ARTs

A

Ipsilateral and contralateral ARTs will be abnormal for both ears

50
Q

children ECV

A

around 1 to 1.2 ml

51
Q

what pure tone results could you see

A

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

52
Q

if you have a r om, what would l art look like

A

left ipsi would only be noral
contra would need to be elevated/abs in order for it to cros over to the unaffected side

53
Q

what speech audiometry results would we expect with OM

A

normal supras (WRS)
sr-pta are in good agreement

54
Q

what is a rising configuration?

A

abnormal lf and rising to normal or close to normal hf hearing

55
Q

what is a sloping configuration?

A

normal to near normal lf and hf abnormal hearing

56
Q

normal to near normal lf and hf abnormal hearing

A

middle ear

57
Q

what would you expect speech to be with CHL with om

A

srt and pta will be in agreement (both are threshold tests)

58
Q

what is a max chl

A

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

59
Q

what is the most common configuration for chl

A

rising
abg
low frequency loss
around 2-3000 becomes normal

60
Q

do all chl look the same

A

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

61
Q

critical learnig language period

A

0-3

62
Q

what are the consequences of OM

A

permanent/temporary chl
damage to me structures
cholesteatoma
permanent hf snhl

63
Q

how can we get permanent hf snhl with om

A

Inner ear structures affected by passive diffusion or active transportation of toxins through round window membrane resulting in a permanent SNHL

64
Q

what damage to middle ear structures do we see with om

A

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

65
Q

why do we see cholesteatoma in om

A
66
Q

what higher order auditory fxn do we see ome

A

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)

67
Q

OME consequences

A

Higher order auditory function

Known long-term implications

Structural changes

68
Q

long term implications of ome

A

attention deficit through adulthood
s/l delays (esl who have ome are at greater risk)
academic failure
behavioral issues
risk factor for CAPD

69
Q

structural changes due to ome

A

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

70
Q

thickened mucous that adheres to the ossicles and adheres them to the mastoid

A

glue ear

71
Q

what is the pseudotumor

A

not a real tumor, but it acts like a tumor
grows rapidly and very invasive

72
Q

w/ chronic/untreated OME or chronic - ve ME pressure

A

cholesteatoma

73
Q

most common reason for visit to pediatricians

A

om

74
Q

what are some societal consequences of om

A

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

75
Q

2nd most common surgical procedure in children

A

Tympanostomy tube placement

76
Q

what are sytpms of chronic ome

A

Can be asymptomatic
May have a hearing loss
May report feeling “plugged”
May report “popping” of ears

77
Q

what are symptoms of acute om

A

Can follow upper respiratory tract infection

Fever

Otalgia

Hearing loss (temporary)

Otorrhea

May have associated systemic symptoms
Nausea
General malaise
Lack of appetite

78
Q

what is the gold standard for diagnosing ome

A

pneumatic otoscopy

79
Q

Standard otoscopy may be useful in visualizing

A

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

80
Q

audiologic diagnosis of OME

A

chl
mixed hl
snhl

flat type b (can have high volume)
type c neg pressure
abnormal gradient/width

abn/abs reflexes

81
Q

what medictions are needed for OME (AOM)

A

antihistamine/decongestants
antibiotics
myringotomy

82
Q

Resolution of condition occurs in 7 to 14 days for ____ of untreated children and _____ of treated children

A

81%
94%

83
Q

____ can typically persist for > 2-3 weeks following antibiotic therapy and after resolution of the actual infection

A

Effusion

84
Q

why are Prophylactic/prolonged antibiotics are contraindicated

A

because of an increase in antibiotic resistance

85
Q

what is prophylcactic

A

prevention

86
Q

why would management include Adenoidectomy and/or tonsillectomy

A

it decreases the need for repeated PE tube replacement

87
Q

what are some compications from OM

A

acute mastoiditis
ossicular erosion (CHL)
SNHL (toxins going through round window)
facial n paralysis
labyrinthine fistula
meningitis
brain abscess

AUDE 5410 Aud-Vestib Disorders (18 decks)

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