Otitis media

Question 1

Inflammation of the middle ear space and is the second most common dz diagnosed in kids

Answer 1

otitis media

Question 2

2 common variants of otitis media

Answer 2

1. acute otitis media

2. otitis media with effusion

Question 3

What does the eardrum look like on pneumatic otoscopy and how do kids present?

Answer 3

1. bulging and yellow/white in color with DILATED vessels

2. sudden onset fever, ear pain and fussiness

Question 4

Common bacteria that cases acute OM

Answer 4

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis.

Question 5

1. Tx of healthy kids >2 w/less severe symptoms
2. If you treat with an antibacterial what is the first line antibiotic?
3. What if you have an allergy to the first line?
4. What types of orgs may be responsible for tx failure?
5. What is a second line therapy for acute OM?

Answer 5

1. Observation for 48hrs
2. amoxicillin (type of penicillin)
3. Azithromycin
4. Beta-lactamase producing or resistant strep.
5. high-dose Amoxicillin-clavulanate

Question 6

1. How can you prevent acute
   OM?
2. RF for acute OM

Answer 6

1. breast feeding, vaccination w/pneumococcal conjucate prep. Abx not sued as much due to concern over dev of resistant orgs
2. daycare, younger sibs, smoke

Question 7

When would kids benefit from pressure equalization (PE) tubes ?

Answer 7

Recurrent acute OM (3-4 bouts of acute OM in 6 mo or 5-6 bouts/yr)

Question 8

How do PE tubes work?

If drainage comes out of the open PE tube what does this indicate?

Answer 8

ventilate the middle ear
Prevent neg pressure and fluid buildup.
Ear infection

Question 9

What are common drops used for PE tubes?

What used to be used but is no longer due to ototoxicity?

Answer 9

1. fluoroquinolone ototopical drops

2. neomycin/polymixin B/hydrocortisone

Question 10

How is OME different than acute OM?

Etiology?

Answer 10

1. middle ear fluid WITHOUT active infection.

2. After acute OM or due to chronic eustachian tube dysfunction.

Question 11

Presentation of OME

Answer 11

asymptomatic, muffled hearing (30-40db conductive hearing loss) or ear fullness. May affect speech dev
NO FEVERS, irritability and ear pain.
Air-fluid behind erdrum and dec mobility of eardrum.

Question 12

Tx of OME may involve short course oral or topical nasal steroids. Why?

Answer 12

dec swelling of eustachian tube

Question 13

What procedure can help reduce need for PE tubes (esp in kids who need second PE tube)

Answer 13

Adenoidectomy - remove adenoid tissue in nasopharynx

Question 14

How does the eustachian tube change as a kid ages?

Who are the exceptions?

Answer 14

Longer and downward slant

Exceptions: kids w/hx of cleft palate or trisomy 21

Question 15

What does unilateral OME in adults potentially be a sign of? And where does it spread later in the dz process?

Answer 15

Early nasopharyngeal carcinoma

Mets to cervical LN –> skull base –> cranial neuropathies

Question 16

7 complications of acute OM

Answer 16

1. perforation of ear drum
2. tympanosclerosis (firm submucosal scarring) –> conductive hearing loss in middle ear and ossicles
3. meningitis
4. mastoiditis
5. epidural and brain abscesses
6. sigmoid sinus thrombosis
7. facial nerve paralysis

Question 17

Most common offending organism causing meningitis related to acute OM. What can this become ?

Answer 17

1. H influenza

2. if fluid is infected –> acute mastoiditis

Question 18

If medical therapy (IV abx) doesnt work to tx acute mastoiditis, what can be done surgically?

Answer 18

PE tube placement or mastoidectomy

Question 19

Define picket fence fever and what complication of acute OM this is seen with

Answer 19

high, spiking fevers with normal temperatures in between.

Sigmoid sinus thrombosis

Question 20

Chronic neg middle ear pressure due to inability to outgrow eustachian tube dysfunction –> retraction of superior part of ear drum called ____. If excess ____ builds up in this area and gets infected, this syndrome is called ____

Answer 20

1. Pars flaccida
2. keratin
3. cholesteatoma

Question 21

cholesteatoma can also occur if ____ epithelium migrates into the middle ear space through ahole in the ear drum due to a previous OM infection

Answer 21

squamous

Question 22

what are the 3 layers of the eardrum?
If ___ and ___ layers meet, the ___ layer will stop so there is a chronic perforation in the middle ear –> low grade inflam

Answer 22

1. cuboidal epithelium in the middle ear
2. fibrous layer in the middle
3. squamous epithelium on the outside.
4. Cuboidal and squamous, fibrous layer

Question 23

why are complications of acute OM uncommon. And what organisms would cause complications?

Answer 23

1. Antibiotics.

2. abx resistant orgs (e.g. strep pneumoniae)

Question 24

Common orgs that cause cholesteatoma/chronic ear drainage

Answer 24

pseudomonas

proteus

Question 25

how do you tx cholesteatoma? Why may it recur?

Answer 25

ototopical abx only improves drainage. Recurrence likely if stopped.
surgery to remove the cholesteatoma is done. Eustachian tube dysfunction is still present so may recur

Question 26

What happens if you dont tx cholesteatoma?

Answer 26

the cholesteatoma will keep growing –> erode bony structure –> hearing loss (necross of long process of incus), erosion of semicirculat canal (dizzy), subperiosteal abscess, facial nerve palsy, meningitis, brain abscess

Question 27

Why is a piece of fascia temporalis or tragal perichodrium harvested as a graft for tympanoplasty?

Answer 27

Fibrous tissue will not grow with squamous epithelium meeting cuboidal epithelium