Otitis Media Flashcards
Peak age in which Otitis Media infections are most frequent?
6-36 months
Otitis Media infections become rare after what age?
8yrs
In what location do most middle ear infections take place?
Tympanic Membrane Space
Three functions of the Eustachian Tube?
1) Equalize pressure on both sides of Tympanic Membrane
2) Protect middle ear from Nasopharyngeal secretions
3) Drain middle ear secretions into Nasopharynx
Progression of Otitis Media infection?
-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.
Some non-modifiable risk factors that increase Otitis Media susceptibility?
- <5yrs
-Male
-FN’s / Inuit populations
-Genetic Factor
-Medical conditions (Down Syndrome & Cleft Palate)
-Recurrent URTI’s
-Allergies
-Decreased Immunity
Modifiable risk factors that increase Otitis Media susceptibility?
-Daycare
-Tobacco Smoke Exposure
-SES
Preventable risk factors increasing Otitis Media susceptibility?
-Lack of (or short period) breastfeeding
-Extended Pacifier use
What would be described as a “Recurrent Otitis Media Infection”?
At least 3 episodes within 6mths
OR
At least 4 episodes within 12mths
What might Recurrent Otitis Infections lead to?
-Alteration to Middle Ear Mucosa
-Damage to Tympanic Membrane / Ossicles
-Adhesions
-Conductive Hearing Loss
Acute Otitis Media diagnosing parameters?
1) Middle Ear Effusion
2) Acute Symptom Onset
3) Significant Middle Ear Inflammation
Acute Otitis Media symptoms that are more commonly seen in kids?
-NVD
-Ear Tugging / Pain
-Crying / Irritability
-Altered Sleep
What sorts of complications may arise from Acute Otitis Media infections?
-Hearing Loss / TM Perforation
-Mastoiditis
-Labyrinthitis
-Meningitis
-Brain Abscess
What % of AOM cases resolve spontaneously w/o treatment?
80%
Top three most prevalent bacterial strains responsible for AOM?
1) S. pneumoniae (25-30%)
2) H. influenzae (20-30%)
3) M. catarrhalis (10-20%)
If a patient comes in with AOM & is <6wks of age, what two bacterial species should be suspected?
E. coli & Group B Strep
What parameters would make AB prescribing an appropriate choice for AOM?
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
What is the directed course of treatment that should be taken if the patient presents as mildly ill with AOM parameters?
24-48hr observation (Watchful Waiting)
What criteria should be followed if “Watchful Waiting” is the treatment course that is chosen?
-Pt. > 6mths of age
-Unilateral Infection
-No anatomical abnormalities or immunocompromised
-Access to AB’s or a timely reassessment
What species should we direct AB therapies towards treating if we suspect AOM?
S. pneumoniae
But be wary of Beta Lactamase resistance to certain AB’s!
Why might high dose Amoxicillin be given?
Overcome S. pneumoniae resistance
Dosing regimen for high dose Amox? Standard?
HD: Amoxicillin 75-90mg / kg / day (divided BID dosing)
SD: Amox 45mg / kg / day (BID division)
2nd line AOM treatment?
Amox/Clavulanate 40-80mg / kg / day (divided into BID dosing)
What parameters would cause one to resort to a 2nd line therapy?
-Purulent Conjunctivitis
-Amox treatment last 30d
-Relapse of recent infection
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)
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.
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)
What % of patients will have remaining effusion after treatment?
50%
Are decongestants or antihistamines good to use for effusion?
Not overly… Don’t decrease symptoms or speed up effusion clearance.
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)
Acute OME? Sub-Acute? Chronic?
Acute: <3wks
Sub-Acute: 3wks-3mths
Chronic: >3mths
What non-specific signs & symptoms may present themselves with OME?
-Rhinitis
-Cough
-Diarrhea
Primary course of treatment to take with OME cases?
Wait and see (!!!)
-Normally resolves spontaneously after 2-3mths.
Treatment of recurrent AOM?
AB’s x 10d
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
Ultimate goal of treating recurrent AOM?
Decrease frequency of AOM by at least 1 episode / yr.
