Otitis Media Flashcards
What is Otitis Media?
Infection of Middle Ear
What age group is Otitis Media most commonly found in?
Kids under 4
What proportion of kids will have at least 1 episode of OM by age 3?
Over 2/3
What is the Pathophysiology of OM? (3 points)
- Nasopharyngeal organisms migrating via Eustachian tube
- Eustachian tube of kids = immature (aka short, straight, wide)
- So infection more likely
What are the common causative BAC of OM? (4 things)
- Strep pneumonia (most common)
- H influenzae
- M catarrhalis
- Staph aureus
What other infections does Strep pneumonia also commonly cause? (2 things)
- Rhino-sinusitis
- Tonsillitis
What are the RF for OM? (6 things)
- Age (peak between 6-15 months)
- Male
- Passive smoking
- Bottle feeding
- Pacifiers (sakaata)
- Craniofacial abn
Which of the RF of OM is a RF for RECURRENT OM?
Pacifiers (sakaata)
What season is OM most common in?
Winter
What are the CF of OM? (5 things)
- Fever (50%)
- Coryzal symptoms
- Ear pain
- Reduced hearing in affected ear
- Discharge (if tympanic memb perforates)
Since pain is hard to interpret in kids, what signs will you see that could suggest they’re in pain? (4 things)
- Tugging / rubbing their ear
- Appear irritable
- Disinterested in food
- Vomiting
What investigations should you do for sus OM?
Otoscopy
What might will you see @ Otoscopy of OM? (3 things)
- Bulging Tympanic membrane (loss of light reflex)
- Erythema (redness) of Tympanic membrane
- Perforation w Purulent Otorrhoea (ear ishaal)
What investigations should you do for sus SEVERE OM?
Bloods (FBC / UnE / CRP)
How should you investigate discharge from the ear in sus OM?
Send for fluid MC&S (microscopy, culture, and sensitivity)
What complications should you investigate for in OM? (4 things)
- Check for Intracranial complications
- Facial Nerve examination
- Signs of inf in throat / oral cavity
- Cervical lymphadenopathy
Why should you test the function of Facial Nerve in sus OM?
Due to its anatomical course thru Middle ear
What DDx present similarly to OM? (3 things)
- Chronic Suppurative Otitis Media (CSOM)
- Otitis Media w Effusion (OME)
- Otitis Externa (OE)
How do you differentiate between OM and OE?
OE will have:
* Erythematous ear CANAL (+/- exudate)
What are the Mx options for OM? (2 things)
- Nothing (can resolve w/o abx within 1-3 days)
- Simple analgesics (paracetamol / ibuprofen)
What do Simple analgesics (paracetamol / ibuprofen) treat in OM? (2 things)
- Pain
- Fever
What are the Abx prescribing options for OM? (3 things)
- No abx
- Delayed prescription
- Immediate abx
When should you give Immediate Abx for OM? (3 things)
- Significant Co-morbs
- Systemically unwell
- Immunocompromised
When should you give a Delayed Prescription of Abx for OM? (2 things)
- Pt demanding abx
- Sus CF might worsen
What is the FIRST LINE NICE recommended Abx for OM?
Amoxicillin (5-7 days)
What are the SECOND LINE NICE recommended Abx for OM? (2 things)
- Clarithromycin (@ penicillin allergy)
- Erythromycin (@ penicillin allergy + pregnant)
What is the Mx option for RECURRENT OM?
Grommets
What are the COMMON complications of OM? (4 things)
- OM w Effusion
- Hearing loss (temporary)
- Perforated Tympanic memb (w pain + reduced hearing + discharge)
- Labyrinthitis (causes dizziness / vertigo)
What are the RARE complications of OM? (4 things)
- Mastoiditis
- Abscess
- Facial nerve palsy
- Meningitis
