Otitis Media Flashcards

1
Q

Peak age in which Otitis Media infections are most frequent?

A

6-36 months

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2
Q

Otitis Media infections become rare after what age?

A

8yrs

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3
Q

In what location do most middle ear infections take place?

A

Tympanic Membrane Space

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4
Q

Three functions of the Eustachian Tube?

A

1) Equalize pressure on both sides of Tympanic Membrane

2) Protect middle ear from Nasopharyngeal secretions

3) Drain middle ear secretions into Nasopharynx

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5
Q

Progression of Otitis Media infection?

A

-Viral URTI causes vasodilation & edema of nose / nasopharynx.

-Eustachian Tubes become occluded & middle ear ventilation impaired… Leads to fluid accumulation (Effusion).

-Nasopharynx flora enter ET / Middle Ear, leading to further Effusion, Bacterial Colonization & Infection.

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6
Q

Some non-modifiable risk factors that increase Otitis Media susceptibility?

A
  • <5yrs
    -Male
    -FN’s / Inuit populations
    -Genetic Factor
    -Medical conditions (Down Syndrome & Cleft Palate)
    -Recurrent URTI’s
    -Allergies
    -Decreased Immunity
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7
Q

Modifiable risk factors that increase Otitis Media susceptibility?

A

-Daycare
-Tobacco Smoke Exposure
-SES

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8
Q

Preventable risk factors increasing Otitis Media susceptibility?

A

-Lack of (or short period) breastfeeding
-Extended Pacifier use

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9
Q

What would be described as a “Recurrent Otitis Media Infection”?

A

At least 3 episodes within 6mths

OR

At least 4 episodes within 12mths

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10
Q

What might Recurrent Otitis Infections lead to?

A

-Alteration to Middle Ear Mucosa
-Damage to Tympanic Membrane / Ossicles
-Adhesions
-Conductive Hearing Loss

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11
Q

Acute Otitis Media diagnosing parameters?

A

1) Middle Ear Effusion
2) Acute Symptom Onset
3) Significant Middle Ear Inflammation

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12
Q

Acute Otitis Media symptoms that are more commonly seen in kids?

A

-NVD
-Ear Tugging / Pain
-Crying / Irritability
-Altered Sleep

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13
Q

What sorts of complications may arise from Acute Otitis Media infections?

A

-Hearing Loss / TM Perforation
-Mastoiditis
-Labyrinthitis
-Meningitis
-Brain Abscess

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14
Q

What % of AOM cases resolve spontaneously w/o treatment?

A

80%

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15
Q

Top three most prevalent bacterial strains responsible for AOM?

A

1) S. pneumoniae (25-30%)
2) H. influenzae (20-30%)
3) M. catarrhalis (10-20%)

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16
Q

If a patient comes in with AOM & is <6wks of age, what two bacterial species should be suspected?

A

E. coli & Group B Strep

17
Q

What parameters would make AB prescribing an appropriate choice for AOM?

A

1) Acute onset of symptoms (ie. irritable, sleep disrupted, poor antipyretic response, severe otalgia, >39 degree fever, >48hrs symptoms)

2) Middle Ear Effusion present

3) Bulging TM

18
Q

What is the directed course of treatment that should be taken if the patient presents as mildly ill with AOM parameters?

A

24-48hr observation (Watchful Waiting)

19
Q

What criteria should be followed if “Watchful Waiting” is the treatment course that is chosen?

A

-Pt. > 6mths of age
-Unilateral Infection
-No anatomical abnormalities or immunocompromised
-Access to AB’s or a timely reassessment

20
Q

What species should we direct AB therapies towards treating if we suspect AOM?

A

S. pneumoniae
But be wary of Beta Lactamase resistance to certain AB’s!

21
Q

Why might high dose Amoxicillin be given?

A

Overcome S. pneumoniae resistance

22
Q

Dosing regimen for high dose Amox? Standard?

A

HD: Amoxicillin 75-90mg / kg / day (divided BID dosing)

SD: Amox 45mg / kg / day (BID division)

23
Q

2nd line AOM treatment?

A

Amox/Clavulanate 40-80mg / kg / day (divided into BID dosing)

24
Q

What parameters would cause one to resort to a 2nd line therapy?

A

-Purulent Conjunctivitis
-Amox treatment last 30d
-Relapse of recent infection

25
If Penicillin allergy, what can be used as an AOM therapy?
i) Cefprozil 30mg / kg / day (divided into BID dosing) ii) Cefuroxime Axetil 30-40mg / kg / day (divided into BID dosing) iii) Clarithromycin 15mg / kg / day (divided into BID dosing)
26
Why are 2nd gen CS's used instead of 1st gen CS's as a 3rd line therapy?
-1st gen CS's poor middle ear penetrance & Beta Lactamase resistance... 2nd gens have better penetrance & get around Beta Lactamase resistance.
27
Azithromycin dosing regimens for AOM?
Day 1: 10mg / kg / day Days 2-5: 5mg / kg / day OR 10mg / kg / day OD x 3d OR 30mg / kg (single dose)
28
What % of patients will have remaining effusion after treatment?
50%
29
Are decongestants or antihistamines good to use for effusion?
Not overly... Don't decrease symptoms or speed up effusion clearance.
30
What distinguishes Otitis Media w Effusion from AOM?
Presence of Effusion w/o other signs of infection (asymptomatic & up to 50% cases mistaken for AOM)
31
Acute OME? Sub-Acute? Chronic?
Acute: <3wks Sub-Acute: 3wks-3mths Chronic: >3mths
32
What non-specific signs & symptoms may present themselves with OME?
-Rhinitis -Cough -Diarrhea
33
Primary course of treatment to take with OME cases?
Wait and see (!!!) -Normally resolves spontaneously after 2-3mths.
34
Treatment of recurrent AOM?
AB's x 10d
35
Treatment of Recurrent AOM (Prophylaxis)?
1) Sulfisoxazole 75mg / kg / day HS 2) Amox 20mg / kg / day HS 3) Cotrimoxazole 0.5mg / kg / day of TMP
36
Ultimate goal of treating recurrent AOM?
Decrease frequency of AOM by at least 1 episode / yr.