Otitis media Flashcards
Inflammation of the middle ear space and is the second most common dz diagnosed in kids
otitis media
2 common variants of otitis media
- acute otitis media
2. otitis media with effusion
What does the eardrum look like on pneumatic otoscopy and how do kids present?
- bulging and yellow/white in color with DILATED vessels
2. sudden onset fever, ear pain and fussiness
Common bacteria that cases acute OM
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis.
- Tx of healthy kids >2 w/less severe symptoms
- If you treat with an antibacterial what is the first line antibiotic?
- What if you have an allergy to the first line?
- What types of orgs may be responsible for tx failure?
- What is a second line therapy for acute OM?
- Observation for 48hrs
- amoxicillin (type of penicillin)
- Azithromycin
- Beta-lactamase producing or resistant strep.
- high-dose Amoxicillin-clavulanate
- How can you prevent acute
OM? - RF for acute OM
- breast feeding, vaccination w/pneumococcal conjucate prep. Abx not sued as much due to concern over dev of resistant orgs
- daycare, younger sibs, smoke
When would kids benefit from pressure equalization (PE) tubes ?
Recurrent acute OM (3-4 bouts of acute OM in 6 mo or 5-6 bouts/yr)
How do PE tubes work?
If drainage comes out of the open PE tube what does this indicate?
ventilate the middle ear
Prevent neg pressure and fluid buildup.
Ear infection
What are common drops used for PE tubes?
What used to be used but is no longer due to ototoxicity?
- fluoroquinolone ototopical drops
2. neomycin/polymixin B/hydrocortisone
How is OME different than acute OM?
Etiology?
- middle ear fluid WITHOUT active infection.
2. After acute OM or due to chronic eustachian tube dysfunction.
Presentation of OME
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.
Tx of OME may involve short course oral or topical nasal steroids. Why?
dec swelling of eustachian tube
What procedure can help reduce need for PE tubes (esp in kids who need second PE tube)
Adenoidectomy - remove adenoid tissue in nasopharynx
How does the eustachian tube change as a kid ages?
Who are the exceptions?
Longer and downward slant
Exceptions: kids w/hx of cleft palate or trisomy 21
What does unilateral OME in adults potentially be a sign of? And where does it spread later in the dz process?
Early nasopharyngeal carcinoma
Mets to cervical LN –> skull base –> cranial neuropathies
7 complications of acute OM
- perforation of ear drum
- tympanosclerosis (firm submucosal scarring) –> conductive hearing loss in middle ear and ossicles
- meningitis
- mastoiditis
- epidural and brain abscesses
- sigmoid sinus thrombosis
- facial nerve paralysis
Most common offending organism causing meningitis related to acute OM. What can this become ?
- H influenza
2. if fluid is infected –> acute mastoiditis
If medical therapy (IV abx) doesnt work to tx acute mastoiditis, what can be done surgically?
PE tube placement or mastoidectomy
Define picket fence fever and what complication of acute OM this is seen with
high, spiking fevers with normal temperatures in between.
Sigmoid sinus thrombosis
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 ____
- Pars flaccida
- keratin
- cholesteatoma
cholesteatoma can also occur if ____ epithelium migrates into the middle ear space through ahole in the ear drum due to a previous OM infection
squamous
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
- cuboidal epithelium in the middle ear
- fibrous layer in the middle
- squamous epithelium on the outside.
- Cuboidal and squamous, fibrous layer
why are complications of acute OM uncommon. And what organisms would cause complications?
- Antibiotics.
2. abx resistant orgs (e.g. strep pneumoniae)
Common orgs that cause cholesteatoma/chronic ear drainage
pseudomonas
proteus
how do you tx cholesteatoma? Why may it recur?
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
What happens if you dont tx cholesteatoma?
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
Why is a piece of fascia temporalis or tragal perichodrium harvested as a graft for tympanoplasty?
Fibrous tissue will not grow with squamous epithelium meeting cuboidal epithelium
