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0.1 Paediatrics - MO > Otitis Media > Flashcards

Otitis Media Flashcards

1
Q

What is otitis media (OM)?

A

An umbrella term for a group of complex infective and inflammatory conditions affecting the middle ear

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2
Q

What do all types of OM involve?

A

Pathology of the middle ear and middle ear mucosa

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3
Q

What is an important subtype of OM?

A

Acute otitis media (AOM) - these cards are really just about AOM

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4
Q

What is AOM?

A

An acute inflammation of the middle ear usually caused by bacterial or viral infection

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5
Q

What is a subtype of AOM?

A

Acute suppurative

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6
Q

What is acute suppurative otitis media?

A

AOM characterised by pus in the middle ear

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7
Q

From where do most infective organisms travel to the middle ear?

A

Nasopharynx

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8
Q

How do organisms travel from the nasopharynx to the middle ear?

A

Via the eustachian tube

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9
Q

Who is more vulnerable to middle ear infections?

A

Younger children

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10
Q

Why are younger children more at risk of OM?

A

The angle between the eustachian tube and the pharyngeal wall is less acute

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11
Q

Why do children become less prone to OM as they get older?

A

The angle between the pharyngeal wall and the eustachian tube becomes more acute

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12
Q

What are most cases of AOM considered to be related to?

A

Preceding or concomitant URTI

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13
Q

What percentage of AOM is due to bacterial infection?

A

~70%

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14
Q

What are the most common bacterial pathogens in AOM?

A
  • Haemophilus influenza
  • Streptococcus pneumoniae
  • Moraxella catarrhalis
  • Streptococcus pyogenes
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15
Q

What are the most common viral causes of AOM?

A
  • RSV

- Rhinovirus

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16
Q

What are the risk factors for developing AOM?

A
  • Younger age
  • Male
  • Smoking in household
  • Daycare/nursery attendance
  • Formula feeding
  • Craniofacial abnormalities e.g. Down’s syndrome/cleft palate
17
Q

How does AOM typically present?

A

With a sudden onset of symptoms

18
Q

What symptoms may be present in AOM?

A
  • Pain (otalgia)
  • Malaise
  • Irritability
  • Poor feeding
  • Fever
  • Coryza
  • Vomiting
19
Q

How may younger children express otalgia?

A

Tugging at their ear

20
Q

What might examination reveal in AOM?

A
  • Fever
  • Red, yellow or cloudy TM
  • Discharge in auditory canal secondary to TM perforation
21
Q

Why is AOM more difficult to diagnose in children under6 months?

A
  • Non-specific symptoms
  • Co-exisiting disease may exist
  • TM may be difficult to see
22
Q

Are investigations usually required in AOM?

A

No

23
Q

If investigations are required what can be done?

A
  • Culture of ear swab
  • Audiometry if hearing loss suspected
  • CT or MRI if suspicious of complications
24
Q

When is audiometry not performed?

A

During the acute infection itself

25
Q

What are some differentials for AOM?

A
  • OME
  • Otitis externa
  • URTI
  • Referred pain from teeth
  • Foreign body in canal
  • TMJ pain
  • Trauma
  • Cholesteatoma
26
Q

What are the indications for hospital admission with AOM?

A
  • Children under 3 with temp >38
  • Children with suspected complications
  • Children who are systemically unwell
27
Q

How are most cases of AOM managed in the community?

A
  • Analgesia
  • Antipyrexials
  • Typically no antibiotics
28
Q

Why are antibiotics not routinely recommended in the management of AOM?

A

They make little difference to symptoms or course of the disease

29
Q

When should antibiotics be considered?

A
  • Systemically unwell
  • High risk of complications due to other conditions
  • Symptoms have lasted 4 or more days with no improvement
30
Q

If antibiotics are required what is the usual prescription?

A

5 days of amoxicillin

31
Q

What can be used in case of penicillin allergy?

A

Erythromycin or clarythromycin

32
Q

What class of antibiotics are erythromycin and clarythromycin?

A

Macrolides

33
Q

What are the potential (but rare) complications of AOM?

A
  • Preforated ear drum
  • Chronic suppurative OM
  • Meningitis
  • Mastoiditis
  • Facial nerve palsy

0.1 Paediatrics - MO (115 decks)

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