otitis media

Question 2

what is acute otitis media

Answer 2

inflammation in middle ear
associated with effusion
accompanied by rapid onset of signs and sx of ear infection

Question 3

what is otitis media with infusion

Answer 3

fluid in the middle ear, but is not associated with symptoms and signs of an acute ear infection

Question 4

what is recurrent acute otitis media

Answer 4

3 or more separate episodes of AOM in 6mo
or 4 episodes in 12mo, with at least 1 in the last 6 mo

Question 5

common pathogens for acute otitis media

Answer 5

bacterial:
* Haemophilus influenzae,
* Streptococcus pneumoniae,
* Moraxella catarrhalis,
* Streptococcus pyogenes

viral
* RSV
* rhinovirus
* adenovirus
* influenza
* parainfluenza

Question 6

epidemiology of AOM

Answer 6

more in children - get more viral infections and have a more horizontal eustachian tube

Question 7

RF for acute otitis media

Answer 7

• Young age.
• Male
• Smoking
• Frequent contact with children
• Formula feeding
• Craniofacial abnormalities (such as cleft palate).
• Use of a dummy.
• Prolonged bottle feeding in the supine position.
• Family history
• Lack of pneumococcal vaccination.
• Gastro-oesophageal reflux.
• Prematurity.
• Recurrent URTI
• Immunodeficiency.

Question 8

px of acute otitis media

Answer 8

improve within 24 hrs with no abx, most within 3days

Question 9

complications of acute otitis media

Answer 9

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

Question 10

sx of acute otitis media

Answer 10

earache
children - olding, tugging, or rubbing of the ear
infective sx - fever, crying, poor feeding, restlessness, behavioural changes, cough, or rhinorrhoea.

Question 11

examination of acute otitis media

Answer 11

exclude mastoiditis, meningitis, intracranial abscess

otoscopy
* red, yellow, or cloudy tympanic membrane
* buldging of membrane, loss of normal landmarks - middle ear effusion
* perforation +- discharge

Question 12

mx of acute otitis media

Answer 12

advise that usual course is 3 days, can last 1 wk
analgesia
consider abx - 5-7 day course of amoxicillin / clarithromycin
review if sx dont improve in 7 days
consider 2nd line abx (co-amox) and refer to ENT

Question 13

mx of recurrent otitis media

Answer 13

refer under 2WW if suspect nasopharyngeal cancer
* otitis media with effusion between episodes - obstruction of eustachian tube orifice
* cervical lymphadenopathy
* epistaxis and nasal obstruction

consider ENT referral

treat as with initial presentation, advicse on avoiding RFs
complete childhood pneumococcal vaccines

Question 14

who needs abx with acute otitis media

Answer 14

Children under the age of two with bilateral OM
Children younger than 3 months with a temperature over 38ºC
OM with ear discharge
Those who are systemically unwell
Those at high risk of complication