Otitis media Flashcards
What is otitis media?
An infection of the middle ear
What often preceeds a bacterial infection of the middle ear?
A viral upper respiratory tract infection
What is the most common bacterial cause of otitis media?
Streptococcus pneumoniae
What are the symptoms of otitis media?
Ear pain
Fever
Irritability
Vomiting
Follows a viral upper respiratory infection
What is glue ear?
Otitis media with effusion
What is the first line management of otitis media?
Otitis media is often self-limiting - first line management is simple analgesia
What antibiotic strategies are there for otitis media?
No antibiotics
Delayed antibiotics
Immediate antibiotics
When should immediate antibiotics be given for otitis media?
When the patient is systemically unwell, immunocompromised or has significant co-morbidities
What are the extra-cranial complications of otitis media?
Facial nerve palsy
Mastoiditis
Labyrnthitis
What are the intra-cranial complications of otitis media?
Meningitis
Sigmoid sinus thrombosis
Brain abscess
What type of hearing loss does glue ear cause?
Conductive hearing loss
What would be seen on examination in a child with unilateral glue ear?
A negative Rinne’s test on the affected side
What are the symptoms of glue ear?
Ear pain
Hearing loss
Tinnitus
What is the treatment of glue ear?
Watchful waiting - first line
Autoinflation - second line
What is autoinflation?
Opening up the eustachain tubes by increasing intranasal pressure - this is done by a special device or by holding nose and breathing out through it
What is seen on otoscopy in glue ear?
A dull tympanic membrane with either air bubbles or a visible fluid level
Can look normal
What are grommets?
Tiny tubes placed in the tympanic membrane that drain fluid from the middle ear into the ear canal
How long do grommets last?
Grommets typically last a year, until they fall out
When should antibiotics be given for otitis media?
If no improvement after 3 days
Younger than 2 years old with exudate
Perforation or discharge in canal
What hearing test do newborns have?
Otoacoustic emission
What hearing test is carried out for children under 4?
Distraction test
What hearing test is carried out in children over 4?
Pure tone audiometry
What hearing test is used if a newborn fails a hearing test?
Automated auditory brainstem response test
What is mastoiditis?
Mastoiditis is an infection of the mastoid bone, behind the ear
What is the presentation of mastoiditis?
Tenderness behind the ear
One ear sticking out more
Ear pain
Irritability
Hearing loss
Fever
What are the common causes of otitis media?
RSV
Rhinovirus
Adenovirus
Influenza virus
Steptococcus pneumoniae
Streptococcus pyogenes
Haemophilus influenzae
What is the first line antibiotic for otitis media?
Amoxicillin
What is the second line antibiotic for otitis media?
Clarithromycin
