Otitis Media Flashcards
What is a middle ear effusion
Fluid in the middle ear
When a patient has otitis media with effusion, what characters of the fluid should be noted
Serous, Mucoid, or Purulent
Is Otitis Media very common?
yes.
Most common reason for AB therapy
Most common diagnosis in sick children in the US
Risk Factors for Otitis Media (10)
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
What factor may decrease the likelihood to AOM in children?
Decreased risk in breastfeeding children
Why is a blockage of the eustachian tube such a big deal?
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.
Oval Window goes to….
Round window goes to….
Inner Ear
Mastoid Air Cells
Cell type in respiratory epithelium
Pseudostratified ciliated columnar epithelium w/ Goblet cells
Functions of the Eustachian tube in the middle ear
Protection
Drainage
Ventilation
If a patient has recurrent infections with OM, what should you consider
Getting a CT to look for a physical blockage of the eustachian tube.
Describe the average pathogenesis of otitis media.
Inflammation -> Eustachian tube destruction -> Middle ear effusion –> AOM –> OME –> Resolution or Complications
Three bacteria that most commonly cause AOM
Streptococcus pneumoniae
Haemophillus influenzae (non-typable)
Moraxella catarhallis
Most common cause of community acquired pneumonia
Strep pneumoniae
Common pieces of an AOM patient history
PAIN
URI, Fever, Headache
Irratability, Apathy
Anorexia, Vomiting, Diarrhea
Common pieces of OME history
Behavior changes Communication Problems Plugged Ears Popping Ears Recent URI or Allergy Symptoms
Five causes of Otalgia?
Otitis externa (Swimmers ear) Ramsay-Hunt (Shingles in auditory canal) TMJ Dental Probs Pharyngitis (Sensory confusion)
DDx concerns for Vertigo, Nystagmus, Tinnitus
Eustachian tube dysfunction
Labrynthitis
DDx concerns for Postauricular swelling
Mastoiditis
Lynphadenitis
DDx concerns for Facial paralysis
Bell’s Palsy (can be caused by inflammation from AOM)
Important AOM findings on physical exam. General Appearance.
Sepsis (general lethargy)
Important AOM findings on physical exam.Head.
Craniofacial abnormalities
Important AOM findings on physical exam. Eyes.
Drainage, haemophilus (non typable)
Important AOM findings on physical exam. Nose.
Polyps, Septal Deviation, Congestion, Drainage
Important AOM findings on physical exam. Throat.
Bifid Uvula, Redness, Drainage, Masses
Important AOM findings on physical exam. Neck.
Masses, Lymph Nodes, Meningismus
What is meningismus
Stiff neck
AOM Tympanic Membrane Triad
Bulging, Immobile, Red
Bubbles seen in TM imply…
Fluid build up with intermittent opening of nasopharynx
What are bullae in TM?
Blisters/Vasicles –> the stretching from fluid expanding is very painful
What is a cholesteatoma?
A growth of keratinous squamous epithelium that forms a benign tumor that if left alone can erode into ossicles and through the TM
If a patient presents with OM and a fever+earache, you should suspect…
Pneumococcal infection
If a patient presents with OM with otitis conjunctivities or bilaterally, you should suspect
H. flu
If a patient presents with tympanic embrane perforation of mastoiditis
Group A Strep
The big diagonal bar you see on tympanic membrane exam (_________) splits the membrane into ______
Manubrium of Malleus
Anterosuperior, Anteroinferior, Posterosuperior, Posteroinferior Quadrants
Name the bump at the bottom of the Manubrium
Umbo
Posteroinferior quadrantis where _____ cna be found
Pars tensa
What does it look like when you see an Air Fluid level in a tympanic membrane
The membrane appears translucent above and opaque below a line demarcating the separation
Which one is the Weber and Rinne test?
Weber on the forehead
Rinne for each ear
Special studies that sometimes occur in AOM patients
Tympanometry
Acoustic reflectometry
Audiometry
Tympanocentesis/Myningotomy
What the tympanometry measure
The impedance of the membrane
When there is negative pressure in the middle ear cavity, the position of the tympanic membrane will be…
retracted
AAP Guidelines for diagnosis of AOM
Acute History (recent URI, congestion) Evidence of middle ear effusion (Drainage, bulging TM, abnormal tympanometry) Signs and/or Symptoms (Fever, Pain)
AOM symptomatic relief may include…
Topical Anesthetic, Analgesics, Local Heat
Treatment of choice for AOM…
Amoxicillin (Amox. clavulanate for haemophilus. Cephlosporins as a back up)
10 day treatment course
When can you provide a treatment course shorter than 2 days?
Patients over 2 years old with no risk factors
How long should it take for antibiotics to have an effect?
24-48 hours.
Recheck in 10-14 days.
Treatment for recurrent OM?
Antibiotic prophylaxis – Amoxicillin or sulfisoxasole half dose
Image adults for masses
Consider myringotomy with tympanostomy tubes
Who is especially likely to need surgery
Young age (first episode under 6 months old) Frequent infections (more than 3/year)
Important considerations in Recurrent OM
Be certain to monitor hearing, speech, and language
OME treatment
Observe (unless infant)
Trial full course of ABs if effusion lasts over 3 months
Surgery
What would you decide surgery for OME was necessary
Effusion lasting 4-6 months
Bilateral effusion
More than 21 dB hearing loss
High Risk
Groups especially at risk for loss of speech and language.
Infants under 6 months Patients wth existing hearing loss or speech/language disorder Autism Craniofacial disorder Developmental Delays Uncorrectable visual impairment
What does a grommet tube do
Holds the TM open until the healing pushes it out
What should you see in OM patients with grommet tubes
Otorheea
Prognosis for AOM
20% resolve spontaneously
Effusion there in 40% one month later
10% 3 months after
20% have recurrent episodes.
Most common AOM complications (Top 7)
Hearing Loss Mastoiditis Perforation Chronic Suppurative Otitis Media Cholesteatoma Facial Paralysis Suppurative labyrinthitis and petrositis
Retractions of the tympanis membrane increase likelihood of….
Choleastoma
Five causes of blockage in the ear canal
Subperiosteal Abscess Extradural abscell Subdural Empyema Brain Abscess Meningitis Lateral Sinus Thrombosis
How to prevent AOM…
Parental Education
Chemoprophylaxis
Surgery
Important components of AOM parental education
NO Smoking
Breastfeed
Vaccines (PCV-13)
Fewer Children in care setting for high risk kids
