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OM Flashcards

1
Q

What is AOM?

A

Acute inflammatory disease of the middle ear and TM with or without purulent middle ear fluid

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2
Q

What is the definition of OME (OM with effusion)?

A

Presence of middle-ear effusion without any local or systemic signs of inflammation

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3
Q

What are the physical exam findings of AOM? (3)

A
  • Bulging
  • Erythema
  • Perforation w/ drainage
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4
Q

What are the symptoms of AOM? (4)

A
  • Otalgia
  • Irritability
  • Fever
  • Ear tugging
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5
Q

What percent of children are diagnosed with OM by 9 months of age?

A

40%

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6
Q

What percent of children are diagnosed with OM by 2 years of age?

A

60%

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7
Q

What is the peak age for recurrence of OM?

A

6-12 months of age

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8
Q

True or false: The incidence of OM is increasing in the developed world

A

False–decreasing

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9
Q

True or false: the heavy burden of OM is still in the developing world

A

true

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10
Q

What are the two ethnicities that have an increased incidence of OM in the US?

A

native american

Eskimo

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11
Q

Children with an atypical course of OM should be worked up for what?

A

Immune workup looking for common variance of immunosuppression, such as IgG subclasses deficiency

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12
Q

Why are kids with T21 more susceptible to OM?

A

Craniofacial abnormality predisposes them

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13
Q

What is the effect of an untreated cleft palate and the incidence of OM?

A

Increased significantly

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14
Q

What is the chromosome that may play a role in predisposition to OM?

A

19q

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15
Q

What are the environmental risk factors for the development of OM? (3)

A
  • Smoking
  • daycare
  • Season
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16
Q

What is the role of breastfeeding and the incidence of OM?

A

Increased risk for 3 or more OM in children who are breastfed less than 6 months

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17
Q

What is the role of pacifiers and the incidence of OM?

A

Unknown

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18
Q

True or false: for the most part, kids with OME are asymptomatic

A

True

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19
Q

What is the main concern with OME?

A

Long term consequences of hearing loss

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20
Q

What is the usual precipitating event for OME?

A

Viral illness

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21
Q

What is the suspected pathophysiology of OME?

A

Eustachian tube dysfunction

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22
Q

What are the three most common pathogens that cause OM?

A
  1. Strep pneumo
  2. H. influenza
  3. Moraxella catarrhalis
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23
Q

What is the trend in the causes of OM?

A

-Increase in H. influ, decrease in Strep

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24
Q

What is the role of antihistamines in the treatment of OM?

A

Do not use

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25
Q

What is the role of corticosteroids in the treatment of OM?

A

Do not use

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26
Q

What is the role of decongestant in the treatment of OM?

A

Do not use

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27
Q

What is the role of allergies in the development of AOM?

A

Thought to play a role, but unsure

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28
Q

What is the relation between kids with gastroesophageal reflux and AOM?

A

Positive correlation, with treatment of GERD leading to decreased rates

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29
Q

What GI protein has been identified within the middle ear of pts undergoing placement of myringotomy for OME?

A

Pepsin and pepsinogen

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30
Q

What is the major preventive strategy against AOM?

A

Immunization

31
Q

What are the vaccines available for AOM?

A

13 valent

23 polysaccharide

32
Q

What, epidemiologically, has changed with the development of the strep pneumo vaccine?

A

Decreased incidence of AOM, and major decrease in invasive disease

33
Q

How is the strep pneumo vaccine made to induce a response to the polysaccharide capsule?

A

Conjugated to the H. influenza protein D

34
Q

What are T cell independent antigens?

A

Ones that do not use T cells to produce an immune response

35
Q

The Hib vaccine is for the polysaccharide capsule. Explain how it is effective.

A

Conjugated to the diphtheroid toxin

36
Q

What is happening to the incidence of non typeable influenzae infections?

A

Increasing

37
Q

What is the most common organism that causes extracranial infections 2/2 recent AOM?

A

Strep pneumo

38
Q

What is the usual presentation of infections of moraxella catarrhalis?

A

Lots of secretions

39
Q

What is the relationship between the flu and AOM?

A

Recent flu infection predisposes to AOM

40
Q

What is the most common etiology of AOM: viral, bacterial, or fungal

41
Q

What is the current treatment approach to AOM?

A

Supportive

42
Q

Under what age is a contraindication for observation of AOM?

A

Under 6 months

43
Q

What are the four major absolute contraindications to just observing AOM?

A
  • Less than 6 months
  • Immunodeficiency
  • Severe illness or previous treatment failure
  • Inability to ensure f/u
44
Q

True or false: previous treatment failure is not a contraindication to observation for AOM

A

False– it is an absolute

45
Q

True or false: an inability to ensure f/u is a contraindication to observing AOM

46
Q

What are the four relative contraindications for observation with AOM?

A
  • Relapse within the last 30 days
  • Otorrhea
  • Bilateral AOM if less than 2 yo
  • Craniofacial malformation
47
Q

Relapse of AOM within how many days is a relative contraindication to observation with AOM?

48
Q

True or false: otorrhea is an absolute contraindication to observation for AOM

A

false–relative contraindication

49
Q

Bilateral AOM under what age is a relative contraindication to observation?

50
Q

What is the first line abx for the treatment of AOM? What about if severe?

A 
Normal = Amoxicillin
Severe = augmentin
51
Q

What is the abx of choice for AOM if there is a PCN allergy?

A

Cephalosporin

52
Q

What is the abx of choice for AOM if there is a PCN and a cephalosporin allergy?

53
Q

When should kids be reevaluated for an episode of AOM with treatment?

A

48-72 hours

54
Q

What are the two abx of choice if there is failure to respond to amoxicillin?

A
  • Augment if not already tried

- Ceftriaxone if has tried above

55
Q

How is ceftriaxone administered?

A

IM q 3 days

56
Q

First line therapy for AOM is not an option if recurrence of AOM is within what timeframe?

57
Q

What is the average course of abx for a short course of AOM? Increased severity?

A 
Average = 5-7 days
Severe = 10 days
58
Q

When is surgical management (TM tube placement) indicated for recurrent AOM?

A

Recurrent AOM, with greater than 3 infections in 6 months
OR
4 infections in 12 months

59
Q

When is TM tube placement indicated for OME? (3)

A

When effusion present over 4 months

  • Significant hearing loss w/ language issue
  • Structural changes in the middle ear
60
Q

True or false: Often there is a dramatic change in kids’ behavior following tympanostomy tube placement

61
Q

What are the signs of chronic, degenerative changes of the middle ear 2/2 recurrent AOM?

A
  • TM perforation
  • Chronic otorrhea
  • Chronic mastoiditis
  • Cholesteatoma
  • Hearing loss
62
Q

What are the two categories of complications with AOM?

A
  • Intratemporal but extracranial

- Intracranial

63
Q

What are cholesteatomas?

A

A destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Usually 2/2 to untreated chronic OM.

64
Q

What are the s/sx of a cholesteatoma?

A

Hearing loss
Otorrhea
Balance issues

65
Q

What are the four major intratemporal, but extracranial infections associated with AOM?

A
  • Mastoiditis
  • Petrositis
  • Labyrinthitis
  • facial nerve palsy
66
Q

What CN involvement is an indication for an emergency TM tube placement?

A

Bell’s palsy

67
Q

What is the classic sign of mastoiditis?

A

Forward ear protrusion

68
Q

Picket fence fevers = ?

A

Sigmoid sinus infections

69
Q

What are the intracranial problems with untreated AOM?

A
  • Meningitis
  • Subdural or brain abscesses
  • Otitic hydrocephalus
  • Sigmoid sinus thrombophlebitis
70
Q

What is otitic hydrocephalus?

A

Idiopathic hydrocephalus 2/2 AOM

71
Q

What are the signs that indicate a complicated course of AOM? (5)

A
  • Low intensity pain for more than one week
  • Foul smelling otorrhea
  • Retroorbital pain
  • Facial nerve palsy
  • Vertigo
72
Q

What type of organisms are associated with mastoiditis with abscesses, and not seen with AOM?

73
Q

What is the most common organism that causes meningitis 2/2 AOM?

A

Strep pneumo

74
Q

What are the two most common bacteria that are associated with cholesteatoma?

A

Pseudomonas

Bacteroides

Specialty Medicine (36 decks)

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