Otitis media Flashcards
What is mucosal otitis media?
Tympanic membrane perforation on presenace of recurrent or persistent ear infection
Wet with inflamed middle ear mucosa and discharge (unless inactive)
What is mucosal otitis media?
Tympanic membrane perforation on presenace of recurrent or persistent ear infection
Wet with inflamed middle ear mucosa and discharge (unless inactive)
What is squamous otitis media?
Gross retraction of tympanic membrane forms a pocket (inactive). Keratin collection forms cholesteatoma (active)
Chronic ear discharge
What is a cholesteatoma?
an accumulation of benign keratinizing squamous cells which are hyperproliferating.
What does a choleastoma do to adjacent bone?
Erode it by producing proteolytic enzymes
Intratemporal complications of otitis media?
- Hearing loss
- Tympanic membrane perforation
- Mastoiditis
- Labyrinthitis
- Facial nerve palsy
Intracranial complciations of otitis media
- Meningitis
- Intracranial abscess
- Lateral sinus thrombosis
- Cavernous sinus thrombosis
- Subdural empyema
Treatment of chronic otitis media
If active discharge -> antibiotic and steroid drops. Self healing if dry
If fails -> surgical repair of tympanic membrane (myringoplasty)
How long do simple tympanic membraine perforations normally take to heal?
Acute otitis media, trauma, iatrogenic
3 months
If not -> myringoplasty
What is acute otitis media?
defined as the presence of inflammation in the middle ear, associated with an effusion and accompanied by the rapid onset of symptoms and signs of an ear infection
How is recurrent AOM defined?
3 + episodes in preceding 6 months OR
4 or more episodes in preceding 12 months with at least one in the last 6
Most common causes of bacterial pathogens AOM
Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Streptococcus pyogenes
Viral causes of AOM
RSV, rhinovirus, adenovirus, influenza, parainfluenzs
Why are children more likely ot get AOM than adults
shorter and more horizontal eustachian tubes
Risk factors for acute otitis media
Young age.
Male sex.
Smoking and/or passive smoking.
Frequent contact with other children such as daycare or nursery attendance or having siblings (increases exposure to viral illnesses).
Formula feeding — breastfeeding has a protective effect.
Craniofacial abnormalities (such as cleft palate).
Use of a dummy.
Prolonged bottle feeding in the supine position.
Family history of otitis media.
Lack of pneumococcal vaccination.
Gastro-oesophageal reflux.
Prematurity.
Recurrent upper respiratory tract infection.
Immunodeficiency
Complications of acute otitis media
Persistent OM with effusion
Recurrence of infection
Hearing loss (usually conductive + temporary)
Tympanic membrane perfoartion
Labyrinthisit
Rarely - mastoiditis, meningitis, intracranial abscess, sinus thrombosis, facial nerve paralysis
Appearance of AOM on otoscopy
Red, yellow or cloudy tympanic membrane
Mod to sev bulging of TM - loss of normal landmarks and air flud level behind
Perforation of TM and/or discharge from EAC
Signs of AOM in children
holding, tugging, or rubbing of the ear, or non-specific symptoms such as fever, crying, poor feeding, restlessness, behavioural changes, cough, or rhinorrhoea
Could aslo show URTI
What is glue ear?
fluid in the middle ear without symptoms or signs of acute infection, causing conductive hearing loss
What is chronic suppurative otitis media
persistent inflammation and perforation of the tympanic membrane with draining discharge for more than 2 weeks
What is myringitis?
erythema and injection of the tympanic membrane are visible on otoscopy but there are no other features of otitis media.
What group of people do you consider admitting with AOM and why?
Children under 3 months of age or under 6 months with a temp above 39 degrees
Risk of coexisting systemic illness eg bronchiolitis or bacteraemia
Likely non specific
TM may not be visible - oblique and collapsable
How long is AOM noramlly slef limiting? What advise?
3 days to 1 week
Paracetemol and ibuprofen management
No antib=histamines or decongestants are useful
When do you prescribe an antibiotic in AOM?
Systemically unwell
otorrhea
<2 years bilateral infection
What can offer if a parent v concerned/anitbiotics may be an option?
Delayed perscription - offer for them to eb able to pick it up after 3 days if no improvement in conditions
What is 1st line antibiotic perscribe for AOM if need?
Amoxicillin 5-7 day course
Clarithromycin, erythromycin (preferred in pregnancy) if allergic to pneicillin
When do yuo prescribe co-amoxiclav in AOM?
When 1st line anitbiotic - amoxicillin - taken for 2-3 days and symptoms are still worseing
Treatment for glue ear
Grommets
