Otis Media Flashcards by Hannah B

What is otitis media?

Is inflammation in the middle ear
May be caused by an infection

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What is the most common paediatric diseases for which medical attention is sought?

Otitis Media

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What is the functions of Eustachian tube?

Equalizing pressure on both sides of the tympanic membrane
Protecting the middle ear from nasopharyngeal secretions
Draining middle ear secretions into nasopharynx

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What does the dysfunction of Eustachian tube lead to?

Impaired the middle ear ventilation

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How otitis media happens?

Viral URTI —> vasodilation and Edelman of nose and nasopharynx
Occculsion of ET —> edema of ET mucosa
Impaired middle ear ventilation
Accumulation of fluid (effusion)

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Risk factors for Otitis Media

Age >5
Gender (slightly more common in males)
More likely in FN and Inuit populations
Family history - suggests a possible genetic factor

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Non-modifiable Risk factors for otitis media

Other medical conditions (anatomic differences)
Recurrent URTI
Allergies
Reduced Immunity

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Modifiable Risk Factors of Otitis Media

DayCare
Exposure to tobacco Smoke
Lack/short period of breast feeding
Extended pacifier use

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How can daycare be a risk factor for otitis media?

Leads to close contact with others potentially sick kids
May be more drug resistant organisms within daycare groups as well

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How can exposure to tobacco smoke be a risk factor for otitis media?

May increase inflammation of mucosal surfaces of nose throat and ears which increases chance of infection
May also impair mucociliary clearance

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How can lack/short period of breast-feeding be a risk factor for otitis media?

Immunoglobulins in breast milk are believed to boost immune system of infant
Should avoid bottle feeding while baby is laying down

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How can extended pacifier use be a risk factor for otitis media?

Increased mucus production with prolonged use may cause reflux of flora into middle ear

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What is the definition of recurrent infections of otitis media?

At least 3 episodes within 6 months
Or at least 4 episodes within 12 months

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What is some effects that recurrent infections can causes?

Alterations in middle ear mucosa
Damage to tympanic membrane and ossicles
Adhesions
Conductive hearing loss

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Types of Otitis Media

Acute Otitis Media (AOM)
Otitis Media with Effusion (OME)
Persistent otitis media
Recurrent otitis media

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What is the diagnosis requirements for otitis media?

Middle ear effusion
Acute onset of symptoms
Significant inflammation of middle ear

Needs all three elements

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Symptoms of Acute Otitis Media

Inflammation/infection
-pain
May see fever
May see N/V/D

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What does the pain look like in a otitis media child?

May see tugging at the ear, crying, irritability, altered sleep patterns

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What are you looking for when looking at the ear?

Redness
Loss of anatomical tympanic membrane
Bulging eardrum

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What are some intracranial complications of acute otitis media?

Meningitis
Subdural or brain abscess

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What are some extracranial complications of acute otitis media?

Hearing loss
TM perforation
Chronic OM
Mastoiditis
Facial paralysis
Tympanosclerosis
Labyrinthititis

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What are some organism that could causes otitis media?

S. Pneumoniae
Non-table strains of haemophilus influenzae
Moraxella catarrhalis
Group A strep
Staph. Aureus

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Goals of Treatment with Otitis Media

Reduction in signs and symptoms
Eradication of infection
Prevention of complications
Avoid unnecessary antibiotic prescribing

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What is antibiotic selection based on?

Spectrum of Activity
Adverse effects
Ability to penetrate the middle ear
Convenience
Cost

What is the first line therapy?

Amoxicillin

What is the amoxicillin dose for acute otitis media?

80 mg/kg/day divided into BID or TID Max 3g/day (USA) Or 75-90mg/kg/day divided into BID 45-60mg/kg/day divided into TID

What is second line therapy for acute otitis media?

Amoxicillin/clav

What is the dose for amox/clav for acute otitis media?

40-80 mg/kg/day divided BID

What are some factors that cause second line to be choose instead of first?

If the initial therapy fails AOM with purulent conjunctivitis Recent treatment with amoxicillin Relapse of recent infection

What is given acute otitis media for penicillin allergic pt?

Cefprozil Cefuroxime Clarithromycin Azithromycin Use of macro like is discouraged

What is the dose for cefprozil?

30mg/kg/day divided BID

What is the dose for cefuroxime axetil?

30-40 mg/kg/day divided BID

What is the dose for azithromycin?

10mg/kg/day day 1 Then 5 mg/kg/day for 4 days Or 10 mg/kg/day once daily for 3 days Or 30 mg/kg single dose

Things to check with antibiotic therapy for AOM

Check dosing For all drugs mentioned What are common side effects Are there important drug interactions What should you tell parent/caregivers?

What is the criteria for watchful waiting?

Age > 6 months Not bilateral (6 months - 23 months) No cranofacial abnormalities, immune deficiency, tympanovstomy tubes or recurrent AOM Access to timely reassessment or antibiotic Rx Reliable caregiver

What is the duration of antibiotic treatment?

Normally 10 day 5 days may be enough for some Uncomplicated AOM >24 months old No perforation of the eardrum

When should you see improvement?

Within 2 to 3 days

What happens if the symptoms persist, worsen or reappear?

Should go back to doctor

What are some nonpharamacolgic treatments?

Heating pad or warm wash cloth - soothing

What are some other pharmacologic treatments?

Glycerin or vegetable oil Auralgan Pain relief (acetaminophen and ibuprofen

How to use glycerin?

-heat to body temp -soothing -Cl with rupture tympanic membrane

How to use auralgan?

It is an antipyretic Warm oil in the ear

Should you use decongestants/antihistamine on otitis media?

What is the biggest side effect with clavulanate?

Diarrhea

Causes of Otitis Media with Effusion

Recent AOM Allergic rhinitis Anatomic problems

What is OME?

Otitis media with effusion Presence of middle ear effusion without any signs of infections

What is the classification of OME?

Acute (<3 wks) Subacute (3 wks - 3 months) Chronic (>3 months)

What are some symptoms of OME?

Decreasing hearing which can impair language development over time Cause scarring of tympanic membrane

What are the opinions of treatment for OME?

Waite and see (resolve in 2-3 months) Second trial of antibiotics Decongestants/antihistamines Corticosteroids Surgical procedures

How are corticosteroids used for OME?

PO not drops Some studies show benefits Shortest course should be used Risk vs benefits

What surgical procedures can be used for OME?

Myringotomy Tympanostomy tubes Tends to be reserved for recurrent cases

What are some treatment of recurrent AOM?

Antibiotics Prophylaxis Surgery Vaccines

What can be used for prophylaxis for recurrent AOM?

Sulfisoxazole Amoxicillin Cotrimoxazole

What is the dose for sulfisoxazole for prophylaxis recurrent AOM?

75mg/kg/d HS

What is the dosing for amoxicillin for prophylaxis recurrent AOM?

20mg/kg/d HS

What is the dosing for cotrimoxazole for prophylaxis recurrent AOM?

0.5mg/kg/d of TMP

Goal of treatment of recurrent AOM?

To decrease frequency of AOM by at least 1 episode a year

What is pharmacists role in Otitis media?

Support/education of non-antibiotic choices Recommendation regarding OTC Instruction regarding proper antibiotic use Follow up for response Compliance - how to improve taste