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ICM - Infectious Disease > Otitis Media > Flashcards

Otitis Media Flashcards

1
Q

What is a middle ear effusion

A

Fluid in the middle ear

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2
Q

When a patient has otitis media with effusion, what characters of the fluid should be noted

A

Serous, Mucoid, or Purulent

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3
Q

Is Otitis Media very common?

A

yes.
Most common reason for AB therapy
Most common diagnosis in sick children in the US

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4
Q

Risk Factors for Otitis Media (10)

A 
Less than 6 yo
Family History
Male
Poor
Alaskan, American, Australian indigenous population
Craniofacial anomalies, nasopharyngeal mass
Cold Season 
Smoke Exposure
Day Care
Pacifier Use
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5
Q

What factor may decrease the likelihood to AOM in children?

A

Decreased risk in breastfeeding children

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6
Q

Why is a blockage of the eustachian tube such a big deal?

A

It can allow negative pressure to build up in the middle ear. When it opens up, the pressure sucks all the contaminated material into the middle ear.

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7
Q

Oval Window goes to….

Round window goes to….

A

Inner Ear

Mastoid Air Cells

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8
Q

Cell type in respiratory epithelium

A

Pseudostratified ciliated columnar epithelium w/ Goblet cells

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9
Q

Functions of the Eustachian tube in the middle ear

A

Protection
Drainage
Ventilation

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10
Q

If a patient has recurrent infections with OM, what should you consider

A

Getting a CT to look for a physical blockage of the eustachian tube.

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11
Q

Describe the average pathogenesis of otitis media.

A

Inflammation -> Eustachian tube destruction -> Middle ear effusion –> AOM –> OME –> Resolution or Complications

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12
Q

Three bacteria that most commonly cause AOM

A

Streptococcus pneumoniae
Haemophillus influenzae (non-typable)
Moraxella catarhallis

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13
Q

Most common cause of community acquired pneumonia

A

Strep pneumoniae

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14
Q

Common pieces of an AOM patient history

A

PAIN
URI, Fever, Headache
Irratability, Apathy
Anorexia, Vomiting, Diarrhea

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15
Q

Common pieces of OME history

A 
Behavior changes
Communication Problems
Plugged Ears
Popping Ears
Recent URI or Allergy Symptoms
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16
Q

Five causes of Otalgia?

A 
Otitis externa (Swimmers ear)
Ramsay-Hunt (Shingles in auditory canal)
TMJ
Dental Probs
Pharyngitis (Sensory confusion)
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17
Q

DDx concerns for Vertigo, Nystagmus, Tinnitus

A

Eustachian tube dysfunction

Labrynthitis

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18
Q

DDx concerns for Postauricular swelling

A

Mastoiditis

Lynphadenitis

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19
Q

DDx concerns for Facial paralysis

A

Bell’s Palsy (can be caused by inflammation from AOM)

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20
Q

Important AOM findings on physical exam. General Appearance.

A

Sepsis (general lethargy)

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21
Q

Important AOM findings on physical exam.Head.

A

Craniofacial abnormalities

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22
Q

Important AOM findings on physical exam. Eyes.

A

Drainage, haemophilus (non typable)

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23
Q

Important AOM findings on physical exam. Nose.

A

Polyps, Septal Deviation, Congestion, Drainage

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24
Q

Important AOM findings on physical exam. Throat.

A

Bifid Uvula, Redness, Drainage, Masses

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25
Q

Important AOM findings on physical exam. Neck.

A

Masses, Lymph Nodes, Meningismus

26
Q

What is meningismus

A

Stiff neck

27
Q

AOM Tympanic Membrane Triad

A

Bulging, Immobile, Red

28
Q

Bubbles seen in TM imply…

A

Fluid build up with intermittent opening of nasopharynx

29
Q

What are bullae in TM?

A

Blisters/Vasicles –> the stretching from fluid expanding is very painful

30
Q

What is a cholesteatoma?

A

A growth of keratinous squamous epithelium that forms a benign tumor that if left alone can erode into ossicles and through the TM

31
Q

If a patient presents with OM and a fever+earache, you should suspect…

A

Pneumococcal infection

32
Q

If a patient presents with OM with otitis conjunctivities or bilaterally, you should suspect

A

H. flu

33
Q

If a patient presents with tympanic embrane perforation of mastoiditis

A

Group A Strep

34
Q

The big diagonal bar you see on tympanic membrane exam (_________) splits the membrane into ______

A

Manubrium of Malleus

Anterosuperior, Anteroinferior, Posterosuperior, Posteroinferior Quadrants

35
Q

Name the bump at the bottom of the Manubrium

A

Umbo

36
Q

Posteroinferior quadrantis where _____ cna be found

A

Pars tensa

37
Q

What does it look like when you see an Air Fluid level in a tympanic membrane

A

The membrane appears translucent above and opaque below a line demarcating the separation

38
Q

Which one is the Weber and Rinne test?

A

Weber on the forehead

Rinne for each ear

39
Q

Special studies that sometimes occur in AOM patients

A

Tympanometry
Acoustic reflectometry
Audiometry
Tympanocentesis/Myningotomy

40
Q

What the tympanometry measure

A

The impedance of the membrane

41
Q

When there is negative pressure in the middle ear cavity, the position of the tympanic membrane will be…

A

retracted

42
Q

AAP Guidelines for diagnosis of AOM

A 
Acute History (recent URI, congestion)
Evidence of middle ear effusion (Drainage, bulging TM, abnormal tympanometry)
Signs and/or Symptoms (Fever, Pain)
43
Q

AOM symptomatic relief may include…

A

Topical Anesthetic, Analgesics, Local Heat

44
Q

Treatment of choice for AOM…

A

Amoxicillin (Amox. clavulanate for haemophilus. Cephlosporins as a back up)
10 day treatment course

45
Q

When can you provide a treatment course shorter than 2 days?

A

Patients over 2 years old with no risk factors

46
Q

How long should it take for antibiotics to have an effect?

A

24-48 hours.

Recheck in 10-14 days.

47
Q

Treatment for recurrent OM?

A

Antibiotic prophylaxis – Amoxicillin or sulfisoxasole half dose
Image adults for masses
Consider myringotomy with tympanostomy tubes

48
Q

Who is especially likely to need surgery

A 
Young age (first episode under 6 months old)
Frequent infections (more than 3/year)
49
Q

Important considerations in Recurrent OM

A

Be certain to monitor hearing, speech, and language

50
Q

OME treatment

A

Observe (unless infant)
Trial full course of ABs if effusion lasts over 3 months
Surgery

51
Q

What would you decide surgery for OME was necessary

A

Effusion lasting 4-6 months
Bilateral effusion
More than 21 dB hearing loss
High Risk

52
Q

Groups especially at risk for loss of speech and language.

A 
Infants under 6 months
Patients wth existing hearing loss or speech/language disorder
Autism
Craniofacial disorder
Developmental Delays
Uncorrectable visual impairment
53
Q

What does a grommet tube do

A

Holds the TM open until the healing pushes it out

54
Q

What should you see in OM patients with grommet tubes

A

Otorheea

55
Q

Prognosis for AOM

A

20% resolve spontaneously
Effusion there in 40% one month later
10% 3 months after
20% have recurrent episodes.

56
Q

Most common AOM complications (Top 7)

A 
Hearing Loss
Mastoiditis
Perforation
Chronic Suppurative Otitis Media
Cholesteatoma
Facial Paralysis
Suppurative labyrinthitis and petrositis
57
Q

Retractions of the tympanis membrane increase likelihood of….

A

Choleastoma

58
Q

Five causes of blockage in the ear canal

A 
Subperiosteal Abscess
Extradural abscell
Subdural Empyema
Brain Abscess
Meningitis
Lateral Sinus Thrombosis
59
Q

How to prevent AOM…

A

Parental Education
Chemoprophylaxis
Surgery

60
Q

Important components of AOM parental education

A

NO Smoking
Breastfeed
Vaccines (PCV-13)
Fewer Children in care setting for high risk kids

ICM - Infectious Disease (11 decks)

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