Otitis Media Flashcards
Subtypes of Otitis Media
Acute Otitis Media (AOM)
Otitis Media with Effusion (OME)
Chronic Otitis Media
Factors involved in Otitis Media
Immunology
Infectious disease
Anatomic considerations
Social and socioeconomic issues (crowding)
Genetics
Pathophysiology of Otitis Media
- Obstruction of Eustachian tube
Mechanical and non-mechanical obstructions - Clearance and defense dysfunction
- Immotile cilia syndrome
- Weakness of related muscle
- Clarence and defence dysfunction
Etiology (causes?) of Otitis Media
Viral
Bacterial
Insult
Leukocyte
Infiltration
Purulent Exudate
ET Obstructions/abnormalities
Resolving cystic fibrosis
Define Otitis Media
Group of inflammation of the middle ear most common in infants and children
State the Eustachian Tube’s Function
- Protection from nasopharyngeal secretions
- Ventilation
- Clearance of middle ear secretions
What is Acute Otitis Media (AOM)
Acute Otitis Media (AOM) is an infection of the ear with rapid onset, presenting with signs and symptoms of acute inflammation, otalgia, and bulging of the Tympanic Membrane (TM)
Define Chronic Otitis Media (OME)
Chronic Otitis Media (OME) is an effusion of the middle ear persisting for ≥ 3 months, which may lead to hearing loss and cholesteatoma formation
Define Otitis Media with Effusion (OME)
Otitis Media with Effusion (OME) is not an ear infection, common in children
- accumulation of non infected fluid in middle ear
Can result from:
• clogging of the Eustachian tube
• sore throat
• URTI
•Common cold
State the Pathophysiology of Acute Otitis Media (AOM)
- Usually follows acute viral upper respiratory infection
- Impairs muco-ciliary system
- Eustachian tube dysfunction in the middle ear
- Bacteria present in >90% of cases
Acute Otitis Media (AOM) is characterized by?
•an opaque, bulging tympanic membrane
• reduced mobility
• purulent effusion
Otitis Media with Effusion (OME)
– relatively asymptomatic middle ear effusion
– Tympanic membrane:
* Translucent or opaque
* Gray/pink
– Reduced mobility
– Effusion present +/- air
– Opacification of the TM
* Best for discrimination of OME from no
effusion
Chronic Mucoid OM (Glue Ear)
– Tympanic membrane:
* Opaque/gray
* Retracted, reduced mobility
* Thick effusion, no air
* Hearing loss
Cholesteatoma
– accumulation of squamous epithelium in
* middle ear &
* Mastoid
– Osteolytic enzymes
– Often accompanied by chronic otorrhea
Chronic Suppurative Otitis Media
– TM perforation+/- cholesteatoma
– Otorrhea
Risk factors for Otitis Media
Attending day care
Passive smoking
Congenital birth defect
Immunocompromised status
State the Diagnosis of OM
- Pneumatic examination
- Tympanometry: Useful for confirming diagnosis (if Pneumatic examination inadequate)
- PCR of middle ear fluid in chronic middle ear effusion
Clinical Presentation of Acute Otitis
Media
- Irritability
- Tugging to the ear
- Otolgia-most specific symptom for AOM esp in older
children - Upper respiratory tract (URT) infection symptoms
- Moderate/severe bulging of TM
- New onset otorrhoea (not d/t otitis externa)
- Mild bulging of TM + ear pain w/in last 48 hours
- Intense erythema of TM
- Fever (T≥ 39 °C)
Classification of Otitis Media
Duration of disease: Acute, subacute, chronic
Quality of effusion: Serous, mucoid, purulent
Appearance of tympanic membrane: Pneumatic otoscope
AOM-Severity of Symptoms Scale (AOM-SOS scale)
Tugging at ear[s]
Increased crying
Irritability
Disturbed sleep
Diminished activity
Diminished appetite
Fever
Goal of management
The goal of treatment includes managing pain
Rational use of antibiotics
Preventing complications and future infection
Ensuring up-to-date vaccination
Treatment AOM in children
– commonly resolve spontaneously and
– antibiotics not routinely recommended
– pain treated with adequate and regular simple
analgesia
* Paracetamol or ibuprofen
* ± adjunct, short-term topical analgesia (severe
acute ear pain)
–e.g. 2% lignocaine: 1-2 drops applied to an intact
tympanic membrane, may be effective
Treatment of Acute Otitis Media
Initial immediate or delayed antibiotics treatment
1st treatment
- Amoxicillin 80-90mg/kg per day PO in two divided doses
- Amoxicillin-Clavulanate: 90 mg/ kg per day of amoxicillin with 6.4 mg/kg per day of clavulanate in 2 divided doses
Alternative therapy
- Cefdinir 14mg/kg per day in 1 or 2 divided doses
- Cefuroxime: 30 mg/kg per day in 2 divided doses
- Cefpodoxime: 10 mg/kg per day in 2 divided doses
- Ceftriaxone: 50 mg/kg IM or IV per day for 3 days
**Antibiotic treatment after 48-72hrs of failure of initial treatment **
1st treatment
- Amoxicillin-Clavulanate: 90 mg/ kg per day of amoxicillin with 6.4 mg/kg per day of clavulanate in 2 divided doses
- Ceftriaxone: 50 mg/kg IM or IV for 3 days
Alternative therapy
- Clindamycin: 30-40 mg/kg per day in 3 divided doses + 3rd-generation cephalosporin
- Ceftriaxone: 50 mg/kg IM or IV per day for 3 days
Treatment of Otitis Media With Effusion
OME usually resolves spontaneously w/in 2 months
* Corticosteroid (orally or intranasally)
– clear chronic middle ear effusion but no efficacy in
AOM
* Antihistamine
* Decongestants
* Antibiotic if none in the last 3 months
* When the effusion is chronic & antibiotic therapy
failure
– surgical intervention
* = placement of tympanostomy tubes
–=> pressure equalization and
–=> drainage of middle ear
What are the Monitoring parameters
- Improvement of symptoms within 72 hours (Ear pain/otalgia, nasal congestion, otorrhea if present)
- Absence of symptoms at the end of antibiotic course
- Side effects and adverse effects of medicines used
- Hearing status
- Utilize the AOM Scale
Indications for Tympanostomy Tubes
• Persistent ME effusion for ≥ 3 months
• Complication of OM: OME associated with hearing loss, Impending intracranial complication, Acute Mastoiditis
• Failure of antibiotic prophylaxis
• Recurrent otitis media with > 3 episodes within a 6 months period or > 4 episodes within a 12 month period
Signs and symptoms in children
Cough orrhinitis
Rhinitis
Cough
Irritability
Fever
