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PHAR 152* > Otitis Media > Flashcards

Otitis Media Flashcards

1
Q

What is otitis media?

A

Inflammation in the middle ear. It can be caused by an infection

It is the most common pediatric disease for which attention is sought

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2
Q

What are the two main types of otitis media?

A

Acute and chronic

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3
Q

How are children impacted by otitis media?

A

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

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4
Q

What are the functions of the eustachian tube?

A

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

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5
Q

How do upper respiratory tract infections make otitis media more likely to develop?

A

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

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6
Q

What are some non-modifiable risk factors associatiated with developing otitis media

A

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

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7
Q

What are some modifiable risk factors associated with developing otitis media?

A

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?

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8
Q

What are recurrent infections?

A

At least 3 episodes of acute otitis media within 6 months or at least 4 within 12 months

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9
Q

What are the consequences of recurrent otitis media?

A

Alterations in middle ear mucosa

Damage to tympanic membrane and ossicles

Conductive hearing loss

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10
Q

What are the four main types of otitis media

A

Acute otitis media (AOM)

Otitis media with effusion (OME)

Persistent otitis media

Recurrent Otitis media

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11
Q

What requirements need to met to diagnose acute otitis media?

A

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

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12
Q

What is the consequence of over-diagnosis?

A

Over-diagnosis contributes to inappropriate antibiotic use and bacterial resistance

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13
Q

What are the symptoms associated with acute otitis media?

A

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

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14
Q

What are some complications associated with AOM?

A

Intracranial:
Meningitis
Subdural or brain abscess

Extracranial:
Hearing loss
tympanic membrane perforation
Chronic OM

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15
Q

What is the etiology of acute otitis media?

A

Streptococcus pneumoniae (25-30%)

Haemophilus influenzae (20-30%)

Moraxella catarrhalis (10-20%)

Other pathogens + 40% of cases also involve viral/bacterial infections

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16
Q

How to select antibiotics for acute otitis media?

A

Spectrum of activity

Adverse effects

Ability to penetrate the middle ear

Convenience

Cost

17
Q

What is the efficacy of antibiotics in acute otitis media?

A

Antibiotics resolved symptoms in 95% of patients, but 80% of people without antibiotics also saw symptom resolution

18
Q

When should antibiotics used?

A

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.

19
Q

What is watchful waiting in relation to otitis media treatment?

A

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.

20
Q

What are the criteria for watchful waiting?

A

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

21
Q

What pathogens should antibiotics target in acute otitis media?

A

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

22
Q

What is the first line therapy for acute otitis media?

A

Amoxicillin 80mg/kg/day BID or TID (max of 3g/day)

23
Q

What should be done if antibiotic therapy for otitis media fails?

A

This probably means the main pathogen produced beta-lactamases. Change agent if no improvement in 3 days

Try Amoxicillin-clavulanate 60mg/kg/day

24
Q

What antibiotics should be used in acute otitis media if patient is allergic to penicillin?

A

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

25
Q

What is tympanocentesis?

A

It is a test that involves getting a sample of middle ear effusion to determine the pathogen causing otitis media.

Usually performed if treatment failure with antibiotics

26
Q

What is the standard duration of antibiotic therapy in otitis media?

A

Traditionally 10 days, but can be shortened to 5 days, especially if case is uncomplicated and the patient is an older child

Improvement should be perceptible within 3 days of starting antibiotics

27
Q

Once the pathogen has been killed by the antibiotics, is the middle ear drained of fluid?

A

In 50% of cases, patients will have effusion remaining following antibiotic treatment

28
Q

What are some non-pharmacological treatments for otitis media?

A

Warm glycerin or vegetable oil with friction between hands. Pour the warm oil into the ear. Do not do this if the ears are draining fluid (indicative of ruptured tympanic membrane)

Heating pad

29
Q

Are anesthetic oils useful in otitis media?

A

No, the anesthetic cannot penetrate into the middle ear. The warm oil is soothing with or without anesthetic

30
Q

Are analgesics useful in otitis media?

A

Yes, use them alongside antibiotics

ex. Acetaminophen, Ibuprofen

31
Q

Are decongestants useful in otitis media?

A

Most studies show no benefit (do not decrease symptoms or speed clearance of effusion)

Probably makes kids more irritable due to CNS side effects

32
Q

What is otitis media with effusion?

A

It is presence of middle ear infection without any signs of infection

Can be mistaken for acute otitis media (cause for uneccessary antibiotic use)

33
Q

What can cause otitis media with effusion?

A

Recent acute otitis media (70% of kids will still have fluid in their middle ear at 2 weeks)

Allergic rhinitis
Anatomic problems

34
Q

What are the consequences of recurrent otitis media with effusion?

A

Decrease hearing which can impair language development over time (need surgery to resolve and prevent hearing loss)

Scarring of tympanic membrane

35
Q

How to treat otitis media with effusion?

A

Wait and see:
May resolve spontaneously after 2 to 3 months

Antibiotics:
Not recomended, but bacteria may be present in 50% of cases

Surgical procedures (reserved for recurrent cases):
Myringotomy
Tympanostomy tubes

36
Q

How to treat recurrent acute otitis media?

A

Antibiotics for 10 days (retreat each time)

Prophylaxis (will not prevent each episode, resistance develops)

Surgery

Vaccines (pneumococcal vaccine)

37
Q

What is a pharmacist’s role in otitis media?

A

Support/educate non-antibiotic choices

Recommendations regarding OTCs

Instructions on proper antibiotic use

Follow-up with patient

PHAR 152* (16 decks)

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