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Pharmacotherapeutics > Otitis Media > Flashcards

Otitis Media Flashcards

1
Q

Define otitis media

A

Group of inflammation of the middle ear, most common in infants and children

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2
Q

Give the subtypes of otitis media and what they are differentiated by .

A

Acute otitis media (AOM)-acute signs of infection
Otitis media with effusion (OME)-presence of middle ear inflammation
Chronic otitis media-presence of fluid in the middle ear

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3
Q

Give function of ET(eustachian tube)

A

*protenction from nasopharyngeal secretions
*ventilation
*clearance of middle ear secretions

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4
Q

Outline
OME

A

OME-collection of non-infected fluid in middle ear without signs of an acute infection
Results from common cold, sore throat or any upper respiratory infection

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5
Q

AOM

A

Infection of ear with rapid onset presenting with signs of acute inflammation, otalgia, bulging of TM(from otoscopic finding)

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6
Q

Chronic OME

A

Effusion(dense) of middle ear persisting for >3 months
May have cholesteatoma formation

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7
Q

Etiology if OM

A

Viral, bacterial , insult, leukocyte, ET abnormalities, resolving cystic fibrosis

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8
Q

Risk factors for OM

A

Attending day care
Passive smoking
Congenital birth defects
Immunocompromised status

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9
Q

Pathophysiology of OM

A
  1. Mechanic obstruction of ET ie tumor
  2. Non mechanic obstruction
  3. Impaired cilia syndrome
  4. Clearance and defense dysfunction
  5. Weakness of related muscle
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10
Q

Bacteria causing AOM

A

S.pneumonia
H. Influenza
M.catarrhalis
Haemolytic streptococcus

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11
Q

Classification of OM

A

Duration of disease(acute, chronic)
Quality of effusion
Serous, mucous, purulent
Appearance of TM ( otoscopic findings)

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12
Q

Clinical Presentation of AOM

A

Irritability
Tugging to the ear
Otolgia
Upper respiratory tract infection symptoms
Fever
Intense erythema of TM
New onset otorrhoea

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13
Q

Otitis media classification based of TM

A

Normal TM-translucent, no erythema, handle of malleus vertical
AOM-TM is bulging and red, inflamed and TM white from puss in the middle , handle of malleus not visible
OME-reduced mobility,effusion present , opacification of TM

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14
Q

What is glue ear(chronic mucoid OM)

A

Hearing loss, thick effusion , no air, opaque/gray

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15
Q

Cholestatoma

A

Accumulation of squamous epithelium in middle ear and mastoid
Osteolytic enzymes
Often accompanied with chronic otorrhea

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16
Q

Diagnosis of OM

A

Pneumatic examination
Tympanometry
PCR of middle ear fluid to identify(S.pneumonia, H. Influenza,M.catarrhalis)

17
Q

Pathogens associated with chronic suppuration OM

A

P. Aeruginosa
S.aureus
K. Pneumonia
Diphtheroids

18
Q

AOM-sos scale for young children

A

Parent asked to rate each of the symptoms twice daily ,during initial 3 days and daily till end of therapy
0=none
1=little
2=a lot

19
Q

AOM-severity score of symptoms scale assess

A

7 items
Irritability
Tugging of ear(s)
Increased crying
Disturbed sleep
Diminished activity
Diminished appetite
Fever

20
Q

Initial Treatment of AOM with no red flag symptoms ie immunocompromised, <6 months, cochlear implant

A

Resolve spontaneously, use of antibiotics not recommended within first 48 hours
Pain-paracetamol 500mg q12h
Topical analgesic- 1-2 drops of 2%lignocaine

21
Q

Treatment with red flag of OM

A
  1. Amoxicillin 80-90mg/kg in 2 divided doses alternative if allergy cefdinir 14mg/kg per day in 1/2 divided doses
  2. If treatment failure after 48-72 hours
    Amox/clav 90mg/kg w 6.4mg/kg in 2 divided doses alternative ceftriaxone IV 3 days 50mg/kg
22
Q

Treatment with red flags if child has received amoxicillin within previous 30 days or suspection H. Influenza/Moraxella beta lactamase producing for OM

A

Amoxicillin-clavulanate 90/6.4 mg/kg/day in 2 divided doses for 10 days alternative
Ceftriaxone 50mg/kg/day IV for 3 days
Or cefuroxime
If treatment fails after 48-72 hours
1. Ceftriaxone
2. Clindamycin 30-40mg/kg/day in 3 divided doses + 3rd gen ceph

23
Q

Before administering ceftriaxone therapy consider?in OM

A

Tympanocentesis - to isolate pathogen
If not feasible clindamycin +\or minus cefixime for H. Influenza coverage

24
Q

Management of OME

A

Resolves in 2 months
Decongestant-pseudoephedrine 60mg q4-6h
Antihistamine for rhinorrea loratidine 10mg OD

25
Q

Monitoring parameters of OM

A

Hearing status
Utilize AOM scale
Improvement of symptoms within 72hr
Side effects ie penicillins allergies rash, hives, gut disturbances
Cephalosporins-hemolytic anemia, C. Difficile infection, renal/liver toxicity, allergic rxn

26
Q

Possible surgical intervention for OM

A

Placement of tympanostomy tubes for drainage and pressure equalization

27
Q

Indication for Tympanostomy Tubes

A

Effusion >3 months
Complications of OM- acute mastoiditis
Failure of antibiotic prophylaxis
Recurrent OM

Pharmacotherapeutics (13 decks)

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