Otitis Media

Question 1

What is the presentation of acute otitis media?

Answer 1

ear ache
bulging and red tempanic membrane
PAIN

Question 2

What is acute otitis media?

Answer 2

URTI involving the middle ear by extension of the infection up the Eustachian tube

Question 3

What commonly causes acute otitis media?

Answer 3

viruses

Question 4

What bacteria can cause AOM?

Answer 4

H.influenzae
Strep pneumoniae
Strep pyogenes

Question 5

How is AOM diagnosed?

Answer 5

clinical history

IF ear drum bursts - can swab the pus

Question 6

How is AOM treated?

Answer 6

80% resolve in 4 days without Abx
1st line - amoxicillin
2nd line - erythromycin

Question 7

What are the 3 ways to describe otitis media with effusion?

Answer 7

serous otitis media

glue ear

Question 8

What is OME?

Answer 8

inflammation of the middle ear accompanied by accumulation of fluid

Question 9

What is the presentation of OME?

Answer 9

Conductive Hearing Loss - may manifest as behavioural problems in young children
NO PAIN
balance problems

Question 10

What populations are most affected by OME?

Answer 10

any child
M>F
day care, older siblings, smoking household, recurrent URTI

Question 11

When would adults be affected by OME?

Answer 11

if they have eustachian tube deformities

Question 12

How is OME diagnosed?

Answer 12

history - presistant hearing loss for a few months
Otoscopy
tuning fork tests - conductive hearing loss
audiometry - age appropriate
tympanometry

Question 13

What signs of OME are seen on otoscopy?

Answer 13

TM retraction and reduced mobitlity
Altered TM colour
visible middle ear fluid/bubbles

Question 14

What is the treatment for OME?

Answer 14

60% resolve in 1 month
90% resolve in 3 months
Review in 3 months and do otoscopy and tympanometry
If symptoms persist >3 months - refer to ENT

Question 15

What is the necessary criteria for OME to be treated surgically?

Answer 15

persistant >3 months bilateral OME
CHL > 25dB
speech/language problems
developmental behaviour problems

Question 16

What is the surgical management of OME for a child <3 years?

Answer 16

Gromit

Question 17

What is the surgical management of OME for a child >3 and first intervention?

Answer 17

Gromit

Question 18

What is the surgical management of OME for a child >3 and second intervention?

Answer 18

Gromit and adenoidectomy

Question 19

What are the possible complications of OME?

Answer 19

infection
discharge
early extrusion 
dont last forever
retention
persistant perforation
swimming/bathing issues

Question 20

What do children with Downs Syndrome or cleft palate get instead of a gromit in OME?

Answer 20

hearing aid - they have a different anatomy of their ear