Middle ear infection Flashcards
What is acute otitis media?
infection of the middle ear
What type of epithelium is found in the middle ear and what is its significance?
pseudostratified columnar epithelium - respiratory epithelium
Significance: middle ear should be thought of as a continuation of resp tract and susceptible to similar pathogens
Which group of pts is acute otitis media most common in ? and what is it related to?
Children - due to eustachian tube dysfunction
What are some common pathogens in acute otitis media?
Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
Do pts with acute otitis media typically start with a viral or bacterial infection?
viral upper respiratory tract infections (URTIs) typically precede otitis media,
BUT - most infections are secondary to bacteria
viral URTIs disturb the normal nasopharyngeal microbiome, allowing bacteria to infect the middle ear via the Eustachian tube
What are clinical features of acute otitis media?
otalgia (children may tug or rub their ear)
fever occurs in around 50% of cases
hearing loss
recent viral URTI symptoms are common (e.g. coryza)
ear discharge- maybe if TM perforates
What are some findings you might get on otoscopy with acute otitis media?
bulging tympanic membrane → loss of light reflex
opacification or erythema of the tympanic membrane
perforation with purulent otorrhoea
decreased mobility if using a pneumatic otoscope
What criteria do you need to meet to diagnose acute otitis media ?
• acute onset of symptoms
- otalgia or ear tugging
• presence of a middle ear effusion
- bulging of the tympanic membrane
- otorrhoea
- decreased mobility on pneumatic otoscopy
• inflammation of the tympanic membrane
- i.e. erythema
What is the management for acute otitis media?
• Conservative – Most patients can be managed conservatively with analgesia
• Medical – In severe or persistent cases oral antibiotics may be required
• Surgery – Recurrent AOM may be helped by grommet
insertion
Acute otitis media is generally self limiting, how long you tell a pt to wait before seeking medical help for symptoms worsening / not improving?
3 days
What situations should you immediately prescribe antibiotics for with acute otitis media?
Symptoms lasting > 4 days / not improving
Systemically unwell but not requiring admission
Immunocompromise or ++ risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
< 2 yrs + bilateral otitis media
Otitis media w/ perforation +/or discharge in the canal
If you were to prescribe an antibiotic for acute otitis media, what you would prescribe and for how long?
1st line:
5-7 day course of amoxicillin
erythromycin for penicillin allergy
What is glue ear?
Otitis media with an effusion
Who gets glue ear?
majority of children have at least one episode during childhood
What are risk factors for Glue ear?
male sex
siblings with glue ear
higher incidence in Winter and Spring
bottle feeding
day care attendance
parental smoking
