Otitis Media

Question 1

Infection or inflammation of the middle ear
– Acute onset of signs and symptoms
– Very common in children,

Answer 1

Acute otitis media

Question 2

Middle ear effusion
– Also known as serous OM, or “glue ear”
– No signs or symptoms of infection

Answer 2

otitis media with effusion (OME)

Question 3

List the risk factors for otitis media

Answer 3

Age (younger) 
• Allergies 
• Upper respiratory tract infections 
Trisomy 21 (Down Syndrome)
Daycare 
• Family history of recurrent OM
• Short duration of breastfeeding
• GERD 
• Immunodeficiency

Question 4

Describe 6 common causative organisms (viral and bacterial) of otitis media

Answer 4

Viruses
• Streptococcus pneumonia
• Haemophilus influenzae
• Moraxella catarrhalis

Occasionally bacterial
• Group A streptococci (GAS)
– Streptococcus pyogenes
• Staphylococcus aureus

Question 5

8 signs and symptoms of acute otitis media

Answer 5

• rapid onset
• otalgia = ear tugging
• otorrhea = drainage from the ear
• headache/fever
• irritability, difficulty sleeping
• loss of appetite
• vomiting, diarrhea

Question 6

4 signs and symptoms of otitis media with effusion (OME)

Answer 6

• hearing loss
• tinnitus = ringing in the ear
• vertigo
• otalgia = ear tugging

Question 7

Recall two reasons why an urgent referral is warranted when assessing potential AOM

Answer 7

• pt is less than 6 weeks of age –> needs sepsis workup

- high risk of complications (immunocompromised)

Question 8

Provide education to patients on antimicrobial therapy for otitis media, including monitoring plan, efficacy, and safety parameters

Answer 8

prevention –> Address modifiable risk factors
Encourage breastfeeding
Immunization
Handwashing

Question 9

3 clinical signs on otoscope exam to confirm diagnoses of AOM

Answer 9

1. redness, inflammation
2. bulging tympanic membrane
3. opaque tympanic membrane

Question 10

Recall 5 goals of therapy in the treatment of AOM

Answer 10

• Cure the infection
• alleviate signs and symptoms
• reduce the risk of complications
• minimize adverse effects
• Modify risk factors to reduce the risk of recurrence

Question 11

Describe when “watchful waiting” might be an appropriate strategy

Answer 11

Some kids will have been resolved within 24 hours without antibiotics

Use the watchful waiting strategy for children:

• more than 6 mos of age with mild symptoms
• more than 24 mos of age with mild symptoms + unilateral or bilateral AOM

Question 12

At what age and symptoms should a pt receive antimicrobial therapy?

Answer 12

children > 6 mos age + moderate-severe symptoms, + fever over 39 degrees
children up to 2 years old with bilateral AOM

Question 13

How long should you monitor for improvement in symptoms?

Answer 13

48-72 hours

Question 14

What is the first line of therapy for otitis media

Answer 14

amoxicillin 40mg/kg/day TID

amoxicillin 90mg/kg/day BID-TID for children less than 2 years old or with ruptured ear drum

Question 15

What medication would you recommend if there is concurrent purulent conjunctivitis (H. influenza)

a) cefuroxime axetil 30 mg/kg/day div BID x 5 days
b) Amoxicillin/clavulanate (7:1) 45 mg/kg/day po div BID x 5 days
c) Doxycycline 4 mg/kg/day div BID (> 8 years old) x 5 days
d) Levofloxacin 10-20 mg/kg/day div Q12-24H

Answer 15

b) b) Amoxicillin/clavulanate (7:1) 45 mg/kg/day po div BID x 5 days

Question 16

What is considered first-line treatment failure in AOM and what treatment would you recommend?

Answer 16

Persistent, significant AOM symptoms despite 48-72 hours of antibiotic therapy

Amoxicillin/clavulanate (7:1) 45 mg/kg/day div BID – TID x 10 days

Question 17

Failure of standard-dose amoxicillin could be because of

Answer 17

beta-lactamase producer or S. pneumonia resistance

Question 18

What are 4 types of medications not recommended for OME?

Answer 18

1. corticosteroids
2. antibiotics
3. antihistamines
4. decongestants

Question 19

What are 2 criteria for recurrent AOM?

Answer 19

3 or more episodes AOM in previous 6 mos

4 or more episodes AOM in previous 12 mos