Module 8.7 - Otitis Media Flashcards
What is otitis media?
Infection of the fluid in the middle ear space, may be acute or chronic, suppurative, or serous in nature.
Describe acute otitis media
it is an acute illness characterized by the presence of middle ear fluid and inflammation of the mucosa that lines middle ear space; usually results from obstruction of the Eustachian tube.
Describe otitis media with effusion
It is characterized by the presence of middle ear fluid without acute signs of illness or inflammation of middle ear mucosa; can result from barotrauma or allergy
What is acute mastoiditis?
mastoid is that portion of the petrous temporal bone that lies superior to the middle ear cavity; most cases of AOM are associated with some degree of mastoid inflammation or infection (mastoiditis); however clinically significant mastoiditis is low due to the introduction of anti-bacterial medications
What is chronic otitis media?
- Diagnostic criteria includes: tympanic membrane perforation in the setting of chronic ear infections, may be benign with a dry tympanic membrane perforation or may have continuous serous drainage (chronic serous otitis media) or chronic purulent drainage through a perforated tympanic membrane (chronic suppurative otitis media).
- Common pathogens for chronic otitis media include: Pseudomonas, Proteus and Staphylococcus aureus.
What causes otitis media?
- Eustachian tube dysfunction or congestion that prevents effective drainage of the middle ear.
- Infectious causative agents (most commonly respiratory pathogens)
What bacterial pathogens cause otitis media?
- Streptococcus pneumoniae 40% of cases
- Haemophilus influenza 25% of cases
- Moraxella catarrhalis 12% of cases
- Group A Strep and Staph aureus 5% of cases
What viral pathogens cause otitis media?
Viral pathogens: may be found in up to 20% of cases
- RSV
- Parainfluenzae
- influenza virus
- rhinovirus
- enterovirus
Co-infection with bacteria is present in more than 40% of viral-induced acute otitis media.
What are the subjective/physical exam findings associated with otitis media?
- Severe, throbbing ear pain (frequently unilateral), which may radiate to the neck/jaw.
- Commonly a recent history of upper respiratory infection, including nasal congestion, sinus pressure/fullness or sore throat.
- Hearing acuity may be diminished on affected side (conductive), with bone conduction enhanced on that side.
- Reddened, inflamed, dull and bulging tympanic membrane (TM) - bony landmarks are obscured.
- Light reflex is distorted or obscured.
- Decreased mobility of tympanic membrane as measure by tympanogram
- Purulent or yellow fluid may be evident posterior to the TM.
- If myringitis (inflammation of the TM) is present, the TM is reddened.
- Severe ear pain with sudden relief usually indicated TM rupture with immediate release of fluid into the middle ear cavity.
- Hole in TM in severe cases if rupture occurs.
Describe the medical management for patient’s with otitis media
A. Antibiotics (oral course for 10 days)
- First line treatment - Amoxicillin 500mg po q 12 hours or 250mg q 8 hours (mild to moderatecases) OR 875mg po q 12 hours or 500mg q 8 hours (severe cases).
a. If allergic to PCN, trimethoprim-sulfamethoxazole (Bactrim) 80/400mg 2 tablets bid for 10 days, or azithromycin (Zithromax) 500mg po first day, followed by 250mg daily days 2-5 - Cefdinir (Omnicef), 600mg daily for 5 days.
- Cefuroxime 500mg po bid.
- Cefpodoxime, 100-200mg po bid.
B. If perforation occurs
- Cortisporin Otic, 4 drops topically tid x 7 days.
C. Analgesic prn for pain
- OTC acetaminophen or NSAIDS, opioids only if needed. Topical analgesic, Auralgan, is effective to relieve pain for NON-PERFORATED, NON-DRAINING otitis media.
D. Refer to ENT for:
- Recurrent acute otitis media (3-4 times in 6 months)
- Chronic otitis media (3 months or more bilaterally; or 6 months or more unilaterally)
- if perforation of tympanic membrane, hearing loss of 20dB or more following treatment.
