Otitis Media Flashcards
What is otitis media?
Inflammation in the middle ear. It can be caused by an infection
It is the most common pediatric disease for which attention is sought
What are the two main types of otitis media?
Acute and chronic
How are children impacted by otitis media?
Kids account for 80% of cases
2/3 of children have an episode by age 3 (peak incidence is between 6 and 36 months)
75% experience at least one ear infection before starting school
Rare in kids older than 8
What are the functions of the eustachian tube?
Has 3 functions:
Equalizing pressure on both sides of the tympanic membrane
Protecting the middle ear from nasopharyngeal secretions
Draining middle ear secretions into nasopharynx
How do upper respiratory tract infections make otitis media more likely to develop?
URTIs cause vasodilation and edema of the nose and nasopharynx.
The inflammation effectively closes the eustachian tubes.
This reduces ventilation of the middle ear, allowing the accumulation of fluid in the middle ear.
Normal flora from nasopharnyx enter the middle ear via eustachian tubes.
The fluid in the middle ear becomes infected with these microorganisms
What are some non-modifiable risk factors associatiated with developing otitis media
Non-modifiable:
Age under 5 (shorter and wider eustachian tube that is more horizontal)
Gender: slightly more common in males
More likely in First Nations and Inuit populations
Family history
Reccurent URTIs
Reduced immunity
What are some modifiable risk factors associated with developing otitis media?
Daycare (exposure to more pathogens)
Increased inflammation of mucosal surface from smoke (increased chance of infection)
Lower socio-economic status (crowded living conditions, and access to care)
Lack/short period of time of breast-feeding?
What are recurrent infections?
At least 3 episodes of acute otitis media within 6 months or at least 4 within 12 months
What are the consequences of recurrent otitis media?
Alterations in middle ear mucosa
Damage to tympanic membrane and ossicles
Conductive hearing loss
What are the four main types of otitis media
Acute otitis media (AOM)
Otitis media with effusion (OME)
Persistent otitis media
Recurrent Otitis media
What requirements need to met to diagnose acute otitis media?
An MD will have to look into the patient’s ear
1.Middle ear effusion
2.Acute onset of symptoms
3.Significant inflammation of middle ear (bulging tympanic membrane)
A red tympanic membrane is not enough
What is the consequence of over-diagnosis?
Over-diagnosis contributes to inappropriate antibiotic use and bacterial resistance
What are the symptoms associated with acute otitis media?
Pain (patient may tug at year, crying, irritability, altered sleep patterns). This pain is due to spontaneous rupture of tympanic membrane
Possible high fever (indicates a more severe infection)
May see N/V/D
What are some complications associated with AOM?
Intracranial:
Meningitis
Subdural or brain abscess
Extracranial:
Hearing loss
tympanic membrane perforation
Chronic OM
What is the etiology of acute otitis media?
Streptococcus pneumoniae (25-30%)
Haemophilus influenzae (20-30%)
Moraxella catarrhalis (10-20%)
Other pathogens + 40% of cases also involve viral/bacterial infections
How to select antibiotics for acute otitis media?
Spectrum of activity
Adverse effects
Ability to penetrate the middle ear
Convenience
Cost
What is the efficacy of antibiotics in acute otitis media?
Antibiotics resolved symptoms in 95% of patients, but 80% of people without antibiotics also saw symptom resolution
When should antibiotics used?
In children 6 months and older:
If the patient experiences the characteristic symptoms (middle ear effusion + bulging TM) for more than 48 hours, offer antibiotics.
What is watchful waiting in relation to otitis media treatment?
Antibiotic treatment is deferred for 24-48h. Observe the child during this period and determine whether antibiotic use is appropriate. Use in combination with analgesics to help with pain.
What are the criteria for watchful waiting?
Older than 6 months
Only on one side
No cranial abnormalities, immune deficiency, tympanostomy tubes or recurrent acute otitis media
Access to timely reassessment or antibiotics (if needed)
Reliable care-giver
What pathogens should antibiotics target in acute otitis media?
80% of acute otitis media (AOM) goes away on its own, but S. pneumoniae is the least likely to resolve on its own. Therefore focus antibiotic therapy on S. pneumoniae, but still be mindful that a diverse set of microbes can cause AOM
What is the first line therapy for acute otitis media?
Amoxicillin 80mg/kg/day BID or TID (max of 3g/day)
What should be done if antibiotic therapy for otitis media fails?
This probably means the main pathogen produced beta-lactamases. Change agent if no improvement in 3 days
Try Amoxicillin-clavulanate 60mg/kg/day
What antibiotics should be used in acute otitis media if patient is allergic to penicillin?
Use second generation cephalosporins
ex. Cefuroxime axetil 30-40mg/kg/day BID
Macrolides are discouraged, not as effective but are a good option if no beta-lactam drugs can be used
ex. azithromycin 10mg/kg/day x 3 days
