Otitis Media 1.0 Flashcards
A father and his 2 year old son, TS, present to your pharmacy. TS’s father states that TS has been very fussy, has been frequently rubbing his left ear, and has a temperature of 37.9°C. He just came from their
family physician who said that TS has a mild case of otitis media and recommended watchful waiting. TS’s father was wanting to get your opinion on this, as he was expecting that TS would get antibiotics.
What is your approach?
???
Incidence of AOM
- a disease of infancy and childhood
- most frequently diagnosed bacterial infection in pediatric patients
• peak incidence between 6 & 9 months
▫ > 60% of children have 1 episode by 1 yr of age
▫ 17% have 3 episodes by 1yr
- If first episode by 6 months, 60% have 2 or more recurrences by 2 years
- 75% of children have at least 1 episode of AOM before starting school
- after 6 yrs of age <40% develop AOM
Predisposing Factors
Immune response:
• to bacterial polysaccharides not fully developed in children <2 years
Eustachian Tube:
• Connects back of throat and middle ear
• Maintains normal air pressure
• Mucocilliary clearance normally ventilate and drain fluid away from the middle ear
• Is smaller and more horizontal in children
Anatomy of the Ear
see slide 6, 7
Predisposing Factors
Most cases follow a viral respiratory illness - one study 22% children 6 months - 3 years old developed otitis media in 1 st week of URI
Common cold
Common cold:
▫ Swelling & thick secretions in eustachian tube
▫ Swelling of adenoid
▫ Obstruction or dysfunction of eustachian tube
▫ Negative middle ear pressure
▫ Fluid stasis and collection in middle ear
▫ Increased colonization of nasopharynx with otitis pathogens
▫ Increased bacterial adherence to mucous promotes bacterial overgrowth
▫ Trapped bacteria may result in bacterial infection
Predisposing Factors
Other factors besides following a viral respiratory illness
• Young age
• Frequent contact with other children and viral illnesses
• Daycare attendance
- Increased viral respiratory illnesses
- Increased exposure to resistant organisms
• Shorter duration breastfeeding
• Bottle feeding, particularly supine
• Environmental tobacco smoke
• Male sex
• Indigenous populations – First Nations, Inuit
• Allergy
• Seasonal peaks in fall and winter
• Orofacial deformities – e.g., cleft palate
Prevention
- Handwashing
- Cleaning of shared toys
- Breast Feeding (even 3 months)
(AAP now encourages exclusive breast feeding for 6 months of life, and to continue for at least the 1 st year and beyond if desired) - Avoidance of second hand smoke
- Avoidance of feeding in flat, supine position
- Reduce pacifier use in children > 6 months
- Influenza vaccine
- Routine pneumococcal conjugate PCV-13 vaccine
Symptoms
- Pain, earache (rubbing, tugging at ear)
- Fever up to 40.5 o C
- Irritability
- Night restlessness
- Poor feeding
- Nausea
- Vomiting
• Often associated with cough and rhinitis
Acute Otitis Media
What are the 2 Requirements?
- Inflammation of the middle ear
2. Fluid in the middle ear
What is Bacterial Otitis Media?
- Bulging, “cloudy, inflamed ear drum”
- Purulent fluid behind the ear drum or purulent otorrhea if tympanic membrane has been ruptured
- Decreased mobility on pneumatoscopy
- Early otitis may appear as inflammation along handle of malleus and in superior pole of tympanic membrane - need to be followed closely
Normal ear drum (picture)
see slide 13
Acute Otitis Media ear drum (picture)
see slide 14
Complications of AOM
common?
rarely?
Common:
• Perforated ear drum
• Otitis Media with Effusion (OME)
• Hearing loss, delayed speech development
Rarely
• Facial paralysis
• Meningitis
• Mastoiditis
• Chronic Suppurative Otitis Media - persistent inflammatory process associated with perforated tympanic membrane and draining exudate for > 6 weeks
Perforated Ear Drum (picture)
see slide 16
Chronic Suppurative Otitis Media (picture)
see slide 17
