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IPFC 2 Midterm 2 > Otitis Media > Flashcards

Otitis Media Flashcards

1
Q

What is pathophysiology steps of getting acute otitis media? (4)

A
  1. Obstruction of eustachian tube
    - allergies or viral URTI cause congestion
  2. Accumulation of secretions in the middle ear
    - middle ear effusion (fluid)
  3. If bacteria/viruses present –> multiply
  4. After resolution, middle ear effusion lasts for weeks–> months
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2
Q

What are risk factors for AOM?

A
  • Age (6-18 months)
  • bottle feeding (breastfeeding is protective)
  • Daycare
  • Pacifier use
  • 2nd hand tobaco use
  • Season (fall/winter)
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3
Q

Why is age the biggest risk factor?

A

Younger kids have more horizontal eustachian tube so there is less drainage

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4
Q

What are common trends of getting AOM in age?

A

-80-90% experience at least 1 episode by age 3

  • peak again 5-6
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5
Q

What are possible AOM symptoms

A
  • Rapid development
  • Symptoms of local inflammation
    (otalgia, EAR PAIN MOST COMMON)
    (decreased hearing due to middle ear effusion)
  • Symptoms of systemic inflammation (fever occurs 1/3 times)
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6
Q

What signs do you look for infants presenting in AOM

A
  • irritability/excessive crying
  • ear rubbing or pulling
  • apathy (lack of interest)
  • restless sleep
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7
Q

How to confirm the diagnosis of AOM? What does it look like?

A

confirmed with visualization tympanic membrane

Abnormal
- Opaque
- White/yellow, or inflamed pink/red
- Decreased/absent mobility (does not move with air blowing in)

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8
Q

What are 2 diagnosis that AOM requires? Signs of each diagnosis

A
  1. Signs/symptoms of middle ear inflammation
    - bulging/red TM, ear pain OR
    - fever

AND

  1. Evidence of middle ear effusion (fluid)
    - TM opaque, decreased TM movement OR
    - otorrhea (drainage/ruptured hole in TM)
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9
Q

What are complications of AOM? (4)

A
  1. TM rupture (bacterial)
    - relieves pressure –> pain relief
    - heals quick
  2. Mastoiditis
    - Pus fills mastoid bone
    - Pain or swelling
  3. Meningitis
  4. brain abscess
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10
Q

What bacteria pathogens can cause AOM?

A
  • S. pneumo
  • non-typeable H. flu
  • M. catarrhalis
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11
Q

How long does it take for AOM symptoms to resolve regardless of etiology

A

3 days

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12
Q

Who is watchful waiting / delayed prescribing? (3-4)

A

6 months+
- mild disease (alert, fever less than 39, pain not disruption sleep, mod. bulging tympanic membrane)
- Have had symptoms LESS THAN 48 HOURS
- Do not have TM perforation/rupture

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13
Q

How to treat if:
- 6mo+, ear pain
- perforated tympanic membrane
- purulent discharge

A

Usually bacterial
- treat with antimicrobials for 10 day

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14
Q

How to treat if:
- 6mo+, ear pain
- Effusion + bulging tympanic membrane
- fever less than 39
- less than 48 hour symptoms

A

Watchful waiting for 24-48 hours (can recommend pain releif)
- if no resolution or worsening symptoms treat with ABX

Less than 2 years treat for 10 days, 2+ years treat with 5 days

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15
Q

How to treat if:
- 6mo+, ear pain
- Effusion + bulging tympanic membrane
- fever over than 39
- less over 48 hour symptoms
- difficulty sleeping

A

Treat with ABX
- Less than 2 years treat for 10 days, 2+ years treat with 5 days

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16
Q

How to treat if:
- 6mo+, ear pain
- no ear effusion
- mildly red tympanic membrane

A

Viral is likely the cause
- watch for 24-48 hours to see if symptoms don’t get better or get worse
- look for signs of bulging tympanic membrane AND middle ear effusion

17
Q

When should you consider reassessment to give ABX if you do watchful waiting (2)

A
  • Symptoms don’t improve within 24-48 hrs OR
  • Development of severe symptoms such as severe pain and fever 39+
18
Q

What medications are not indicated for patients looking for symptom relief.

A

Decongestants or antihistamines
- do not give tylenol if they have fever and are feeling well
- treat the person not the number

19
Q

When can you not use lidocaine? (2)

A
  • under 2
  • perforated TM
20
Q

What type of therapy is usually given for AOM

A

Mainly Empiric therapy

21
Q

What does H. influ type B (HIB) conjugated vaccine protect against?

A

Bacterial meningitis

22
Q

Which bacteria is more likely with purulent conjunctivitis (eye) AND failed amoxicillin (2)

A
  • non-typeable BETA-LACTAMASE H. influ
  • M. Catarrhalis
23
Q

Which bacteria is more likely in tympanic membrane perforation and otorrhea present?

A

Group A strep

24
Q

Which vaccine would you give to get less AOM

A
  • S. pneumo conjugated vaccines
  • PCV7
  • PCV13
25
Q

Which bacteria’s should you try to target for otitis media in general

A
  • S. pneumo
  • non-beta lactamase H. influ
26
Q

What ABX is preferred for most patients with AOM?

A

Amoxicillin

27
Q

When would you use high dose amox? (3)

A
  • under 2, over 65
  • Daycare
  • Previous antibiotic use in last 90 days
28
Q

When do you use amoxi-clav in patients? (3)

A
  1. Patients who present with purulent conjunctivitis (eye)
    - m. catarrhalis more likely
  2. Patients who fail amoxicillin
    - (symptoms not improved within 24hrs, resolved within 3 days)
  3. Patients who have taken amoxicillin past 30 days
29
Q

What are 2 good alternatives to amoxicillin?

A

2nd gen cephalosporin
- Cefuroxime (different side-chain)
- Cefprozil (do not give if IgE allergy to amox)

30
Q

What do you give if patients fail amoxi-clav?

A

Ceftriaxone

31
Q

When should you give treatment for 10 days? (3)

A
  1. if under 2 years
  2. if they have perforated TM
  3. Failure of any initial therapy
32
Q

When should you see symptom improvement and resolution. consider all symptoms

A

improve: within 24 hours
resolve: within 3 days

MEE (fluid) can persist for months

33
Q

When are recurrent AOM common? What is the treatment?

A

In patients who get it before 6 months old, or siblings with recurrent AOM
- 3+ within 6 mos, 4+ within 1 year

Treat for 10 days

IPFC 2 Midterm 2 (5 decks)

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