Otitis Media Flashcards
What is Acute Otitis Media?
Acute Onset of Middle Ear Effusion and Middle Ear Inflammation
Who gets AOM?
Most frequent diagnosis in sick children visiting the GP and most common reason for administration of ABx.
Peak incidence between 6-15 months
The primary defect in infants which leads to AOM is Eustachian tube dysfunction/obstruction which leads to stasis and then colonisation of pathogens.
What pathogens can cause AOM?
Viral (RSV, influenza, parainfluenza, adenovirus) (25%)
Streptococcus pneumonia (35%)
Non-typable strains of Haemophilus influenza (25%)
Moraxella catarrhalis (15%)
What are the some modifiable and non-modifiable risk factors of AOM?
Non-modifiable: young age, FHx of OM, prematurity, orofacial abnormalities, immunodeficiencies, Down’s Syndrome
Modifiable: lack of breastfeeding, day care attendance, exposure to cigarette smoke and air pollutions, pacifier use.
What are the main features on history to be elicited?
Fever
Acute onset of otalgia in a verbal infant but ear tugging in a preverbal infant.
+/- anorexia, vomiting, lethargy
Otorrhoea (discharge from the ear)
Decreased hearing
What are the clinical features on examination and otoscopy that will be seen?
With otoscopy: will see signs of both Middle Ear Effusion and Inflammation
Middle Ear Effusion -> immobile tympanic membrane (with pneumatic otoscopy), acute otorrhoea, loss of bony middle ear landmarks (handle of malleus, incus, light reflex), tympanic membrane is dull and opaque.
Middle Ear Inflammation -> bulging tympanic membrane with altered colour on the tympanic membrane but is characteristically yellow-grey
Febrile
Associated signs of URTI: coryza, red tonsillopharynx, cough etc. which could point to a viral illness
What does glue ear mean and how does it come about?
If the middle ear infection persists for several weeks or months following the episode of AOM then it could cause conducive hearing loss. There are recurrent episodes of AOM over a period of time. There can be a thicker fluid in the middle ear behind the drum which in effect makes it harder for the child to hear.
What are some other complications of AOM?
*Perforation of the TM: leads to purulent otorrhoea and the RELIEF of pain
* Febrile Convulsions
Infective/Suppurative Complications (rare): mastoiditis, suppuratives labyrinthitis or intracranial infection (e.g meningitis, abscess formation)
Other: facial nerve palsy, lateral sinus thrombosis, benign intracranial HTN
How do you manage a child who has AOM?
Most children resolve spontaneously without any ABx. If the child is above 12 months, only mildly unwell with a fever
