Otitis Media Flashcards
What is otitis media (OM)?
An umbrella term for a group of complex infective and inflammatory conditions affecting the middle ear
What do all types of OM involve?
Pathology of the middle ear and middle ear mucosa
What is an important subtype of OM?
Acute otitis media (AOM) - these cards are really just about AOM
What is AOM?
An acute inflammation of the middle ear usually caused by bacterial or viral infection
What is a subtype of AOM?
Acute suppurative
What is acute suppurative otitis media?
AOM characterised by pus in the middle ear
From where do most infective organisms travel to the middle ear?
Nasopharynx
How do organisms travel from the nasopharynx to the middle ear?
Via the eustachian tube
Who is more vulnerable to middle ear infections?
Younger children
Why are younger children more at risk of OM?
The angle between the eustachian tube and the pharyngeal wall is less acute
Why do children become less prone to OM as they get older?
The angle between the pharyngeal wall and the eustachian tube becomes more acute
What are most cases of AOM considered to be related to?
Preceding or concomitant URTI
What percentage of AOM is due to bacterial infection?
~70%
What are the most common bacterial pathogens in AOM?
- Haemophilus influenza
- Streptococcus pneumoniae
- Moraxella catarrhalis
- Streptococcus pyogenes
What are the most common viral causes of AOM?
- RSV
- Rhinovirus
What are the risk factors for developing AOM?
- Younger age
- Male
- Smoking in household
- Daycare/nursery attendance
- Formula feeding
- Craniofacial abnormalities e.g. Down’s syndrome/cleft palate
How does AOM typically present?
With a sudden onset of symptoms
What symptoms may be present in AOM?
- Pain (otalgia)
- Malaise
- Irritability
- Poor feeding
- Fever
- Coryza
- Vomiting
How may younger children express otalgia?
Tugging at their ear
What might examination reveal in AOM?
- Fever
- Red, yellow or cloudy TM
- Discharge in auditory canal secondary to TM perforation
Why is AOM more difficult to diagnose in children under6 months?
- Non-specific symptoms
- Co-exisiting disease may exist
- TM may be difficult to see
Are investigations usually required in AOM?
No
If investigations are required what can be done?
- Culture of ear swab
- Audiometry if hearing loss suspected
- CT or MRI if suspicious of complications
When is audiometry not performed?
During the acute infection itself
What are some differentials for AOM?
- OME
- Otitis externa
- URTI
- Referred pain from teeth
- Foreign body in canal
- TMJ pain
- Trauma
- Cholesteatoma
What are the indications for hospital admission with AOM?
- Children under 3 with temp >38
- Children with suspected complications
- Children who are systemically unwell
How are most cases of AOM managed in the community?
- Analgesia
- Antipyrexials
- Typically no antibiotics
Why are antibiotics not routinely recommended in the management of AOM?
They make little difference to symptoms or course of the disease
When should antibiotics be considered?
- Systemically unwell
- High risk of complications due to other conditions
- Symptoms have lasted 4 or more days with no improvement
If antibiotics are required what is the usual prescription?
5 days of amoxicillin
What can be used in case of penicillin allergy?
Erythromycin or clarythromycin
What class of antibiotics are erythromycin and clarythromycin?
Macrolides
What are the potential (but rare) complications of AOM?
- Preforated ear drum
- Chronic suppurative OM
- Meningitis
- Mastoiditis
- Facial nerve palsy
