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Y5 Paeds > Otitis media > Flashcards

Otitis media Flashcards

1
Q

Define acute otitis media

A

Inflammation in the middle ear that is accompanied by the rapid onset of symptoms and signs of an ear infection, associated with effusion

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2
Q

Define persistent otitis media

A

Symptoms persist after initial management or because symptoms are worsening

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3
Q

Define recurrent otitis media

A

3 or more well-documented and separate AOM episodes in the preceding 6 months, or 4 or more episodes in the preceding 12 months

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4
Q

What are the causes of acute otitis media

A

Bacterial:
* Haemophilus influenzae
* Streptococcus pneumoniae
* Moraxella catarrhalis
* Streptococcus pyogenes
Viral:
* RSV
* Rhinovirus
* Adenovirus
* Influenza virus
* Parainfluenza virus

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5
Q

What are the risk factors for acute otitis media

A
  • 6-24 months of age
  • Winter season
  • Lack of pneumococcus vaccination
  • Male sex
  • Smoking and/or passive smoking
  • Frequent contact with other children e.g. daycare, nursery, siblings
  • Formula feeding (breastfeeding is protective)
  • Craniofacial abnormalities e.g. cleft palate
  • Dummy usage
  • Prolonged bottle feeding in supine position
  • FHx otitis media
  • Gastro-oeseophageal reflux
  • Recurrent URTI
  • Immunodeficiency

Infants have a shorter, wider, more horizontal, and floppy Eustachian tube than adults, which increases the likelihood of middle ear infection

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6
Q

What are the symptoms of acute otitis media

A

Older children/adults: earache
Younger children:
* Holding, tugging, rubbing of the ear
* Fever
* Crying
* Poor feeding
* Restlessness
* Behavioural change
* Cough
* Rhinorrhoea

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7
Q

What are the signs of otitis media on examination

A

Otoscopic ear examination
* Red, yellow, or cloudy tympanic membrane
* Bulging of the tympanic membrane
* Loss of normal landmarks
* Air-fluid level behind the tympanic membrane (indicates a middle ear effusion)
* Perforation of the tympanic membrane and/or discharge in the external auditory canal

Features that suggest that it’s NOT otitis media:
- Tympanic membrane not bulging ± erythema/cloudiness
- Air-fluid level without bulging tympanic membrane

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8
Q

What are the differentials for otitis media

A

URTI
Glue ear (OM with effusion)
Chronic suppurative otitis media
Otitis externa
Eustachian tube dysfunction
Mastoiditis
Malignancy

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9
Q

What investigations should be done for otitis media

A

Basic observations
Otoscopic examination
Pneumatic otoscopy: impaired ear drum mobility

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10
Q

What features necessitate admission for otitis media

A

Severe systemic infection
Less than 3 months old with temp. >38oc
Immunocompromised
Suspected acute complications:
- Meningitis
- Mastoiditis
- Intracranial abscess
- Sinus thrombosis
- Facial nerve paralysis

Consider IV ABx

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11
Q

What is the a management for otitis media in a child who is systemically well

A

Supportive:
* Advise on the course of disease (3-7 days)
* Will resolve spontaneously, seek help if symptoms do not improve
* Paracetamol or ibuprofen for pain
* Back-up Abx prescription
* Ear drops with anaesthetic/analgesic:
*```
Contraindicated: ear drum perforation, otorrhoea
* For children <18yo who are not prescribed antibiotics
~~~

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12
Q

What is the management for a child with otitis media who is systemically unwell

A

First line: amoxicillin for 5-7 days
Second line: co-amoxiclav

+supportive

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13
Q

What is the management for acute otitis media with perforation

A

Oral amoxicillin, 5 days
Review in 6 weeks to ensure healing

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14
Q

What are the compliclations of acute otitis media

A

Persistent otitis media with effusion
Recurrence of infection
Hearing loss (usually conductive and temporary)
Tympanic membrane perforation
Labyrinthitis
Mastoiditis, meningitis, intracranial abscess, sinus thrombosis, facial nerve paralysis

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15
Q

What is the prognosis for acute otitis media

A

Excellent prognosis
Without antibiotic treatment: symptoms improve within 24 hours in 60% of children, most recover within 3 days
Recurrent episodes are not common, but if they are present they usually resolves as the child gets older
Long term complications are rare

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16
Q

Define chronic suppurative otitis media

A

A chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges (otorrhoea) through a tympanic perforation
Persistent (>2 weeks) drainage through an eardrum perforation

17
Q

What are the causes of chronic suppurative otitis media

A

CSOM can be caused by bacterial and/or fungal infection (often polymicrobial), including:
* Pseudomonas aeruginosa (most common).
* Staphylococcus aureus.
* Proteus species.
* Aspergillus species.
* Candida albicans.

18
Q

What are the risk factors for Chronic suppurative otitis media

A

Younger age — children under 5 years old are most commonly affected.
Allergy/atopy.
Upper respiratory tract infection.
Acute or recurrent otitis media.
Exposure to second-hand smoke.
Social deprivation.
Snoring.

19
Q

What are the symptoms of chronic suppurative otitis media

A

Ear discharge persisting for more than 2 weeks, without ear pain or fever.
Hearing loss in the affected ear.
A history of acute otitis media (AOM), ear trauma, or glue ear and grommet insertion
A history of allergy, atopy, and/or upper respiratory tract infection.
Tinnitus and/or a sensation of pressure in the ear may also be present.
Examination of the ear may reveal tympanic membrane perforation and/or middle ear inflammation.

20
Q

What is the management for chronic suppurative otitis media

A

keep dry + refer to ENT

21
Q

What is otitis media with effusion

A

Condition characterised by a collection of fluid within the middle ear space without signs of acute infection

22
Q

What is the epidemiology of otitis media with effusion

A

Common in children between 6 months and 4 years old
Most common cause of hearing impairment in childhood
>50% of children will experience OME in the first year of life
Prevalence of OME in children with Down syndrome or cleft palate is 60–85%.
OME is most common in the winter months.

23
Q

What are the symptoms of otitis media with effusion

A

Hearing loss
- May have been picked up on the newborn hearing screening test (OAE)
- Mishearing
- Difficulty communicating in a group
- Asking for things to be repeated
- Listening to the media at excessively high sound levels
Mild intermittent ear pain with fullness or ‘popping’
Aural discharge (Persistent, foul smelling)
Recurrent ear infections, URTI, or nasal obstruction

24
Q

What are the signs of otitis media with effusion on examination

A

Otoscope
Effusion: Serous, mucoid, or purulent
Abnormal colour of the drum e.g. yellow, amber, blue
Loss of light reflex or a more diffuse light reflex
Opacification of the drum
Air bubbles or an air/fluid level
A retracted, concave, indrawn drum, fullness or bulging
Usually no signs of inflammation or discharge on examination

25
Q

What investigations should be done for otitis media with effusion

A

Pneumatic otoscopy
Typanometry
Audiometry

26
Q

What features necessitate referral for ENT assessment for otitis media with effusion

A

Persistent foul smelling discharge (choleastoma)
Hearing loss, impact on development/education
Severe hearing loss or significant on two occasions
Structural abnormality of the tympanic membrane
Down’s syndrome or cleft palate

27
Q

What is the management for otitis media with effusion

A
  1. Watchful waiting for 3 months (spon. resolves
  2. 2 hearing tests at least 3 months apart (pure tone audiometry) + tympanometry
  3. Consider autoinflation or valsalva manouevre in older children (blowing a bloon via the nostril 2-3x a day)

Consider need for hearing aids
No resolve -> refer to ENT specialist
Surgery: myringotomy and grommet insertion

Y5 Paeds (131 decks)

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