Otitis media Flashcards
Define acute otitis media
Inflammation of the middle ear with an associated effusion
Can be bacterial or viral.
What is the relevant epidemiology of acute otitis media?
Common - particularly in young children
Often after a viral upper respiratory tract infection
Affects 70% of children before age 2yrs, peak between 6-15m
What are the most common pathogens causing acute otitis media?
Streptococcus pneumoniae
Haemophilius influenza
Moraxella catarrhalis
What virus can cause acute otitis media?
Respiratory syncytical virus
Adenovirus
Enterovirus
What are the risk factors for acute otitis media?
Age below 2yrs
Male sex
Parental smoking
Immunodeficiency
Formular feeding
Nursey or daycare
Structural abnormality - Down syndrome or cohclear implants
Recurrent - GORD or dummies
What symptoms are common in acute otitis media?
Earache
Ear tugging in younger children
Pain
Fever
Irritability
Anorexia
Vomiting
What does otoscopy of acute otitis media look like?
Erythema of tympanic membrane
Presence of an effusion in the middle ear - air fluid levels bulging tympanic membrane
Evidece of perforation
What are some red flag symptoms to screen for in acute otitis media?
Changes to vision
Photophobia or headache
Nystagmus
Post auricular swelling
Facial paralysis
What is the appearance of a chronic benign otitis media?
Dry tympanic membrane perforatoin without chronic infection
What is the sign of otitis media with effusion (glue ear)?
Persistent presence of middle ear effusion without acute infective symptoms
What are the features of chronic suppurative otitis media?
Persistent purulent drainage through perforate tympanic membrane
What are the key features of otitis external?
Ear pain
Itching
Discharge
Hearing loss
Sloughy discharge within the ear canal.
What specialised investigations may be done in rare cases of acute otitis media?
Culture of discharge in chronic or recurrent AOM
CR or MRI if ?mastoiditis or intracranial spread
Audiometry after resolution in chronic hearing loss suspected as complication
When should children with acute otitis media be admitted to hospital?
Under 3m with temp >=38
Suspected meningitis, mastoiditis or facial nerve palsy
Severely systemically unwell
When might antibiotics be given for acute otitis media?
Is child systemically unwell or high comp risk
If otorrhoea
If <2yrs and bilateral
What anitbiotics are typically given for acute otitis media?
Amoxicillin for 5-7days
Clarithroymycin if allergic
If no improvement after 2-3days -> then co-amox
How is acute otitis media managed? (NOT antibiotics)
Paracetamol and warm ear compress for pain
Eardrops - anaesthetic and analgesic - phenazone 40mg/g with lidocaine 10mg/g
Delayed antibiotic prescription is no improvement within 3 days
What are the extra-cranial complications of otitis media?
Facial nerve palsy - LMN
Mastoiditis - abscess in mastoid air spaces - post auricular swelling and mastoid tenderness
Petrositis - gradenigo syndrome - otorrhoea, deep ear and eye pain, ipsilateral VI nerve palsy
Labyrinthitis - inflammation of the semi-circular canals -> vertigo, nausea, vomiting and imbalance
What are some intra-cranial complications of otitis media?
Meningitis - sepsis, headache, vomiting, photophobia, phonophobia
Sigmoid sinus thrombosis - sepsis, swinging pyrexia, meningitis
Brain abscess - sepsis and neurological signs due to compression of cranial nerves
What chronic complications can occur from acute otitis media?
Hearing loss
Otitis media with effusion (glue ear) - may require grommets if >3yrs or language/behavioural problems
Chronic suppurative otitis media - perf cause re-infection - can cause conductive hearing loss.
When is acute otitis media considered recurrent?
More than 3 episodes in 6 months
More than 4 episodes in one year
