Otitis Media Flashcards
What are some of the most common causative organisms of acute otitis media?
Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus Group A strep
What are some patient factors that my contribute to the development of acute otitis media?
Eustachian tube dysfunction
Eustachian tube obstruction
Immune dysfunction
List some common clinical manifestations of acute otitis media:
preceding URI or exacerbation of allergic rhinitis
Unilateral otalgia
Decreased/muffled hearing
If TM has ruptured, Hx of sudden relief
Disequilibrium may be present but not common
What symptoms are concerning for unusual complications of acute otitis media?
High fever
Severe pain behind the ear
Facial paralysis
What do you expect to see in a patient with acute otitis media on otoscopy?
Bulging TM
Reduced mobility of TM
List DDx of acute otitis media:
Otitis media with effusion (OME) Chronic otitis media (COM) Otitis externa Herpes zoster Bullous mryingitis Other deep space head and neck infections
What condition is believed to be viral and can cause vesicles to develop on the TM and mimic acute otitis media?
Bullous mryingitis
What syndrome is characterized by the triad of ipsilateral facial paralysis, ear pain, and vesicles involving the auditory canal and auricle?
Ramsay Hunt syndrome (herpes zoster oticus)
What is the initial choice of abx for acute otitis media?
amoxacillin-clavulanate
875mg/125mg
What antibiotics can be used in patients with acute otitis media who have severe allergy to beta-lactam abx and cephalosporins?
Doxycycline
Azithromycin
Clarithromycin
What topical preparations should be avoided in patients suspected of having a perforated TM?
Acetic Acid Acetic Acid and hydrocortisone Neomycin polymyxin B and hydrocortisone Neomycin, colistin and hydrocortisone Gentamicin and prednisolone Tobramycin Gentoamicin
When should you refer an acute otitis media patient to ENT?
Pt with recurrent unilateral AOM, more than two episodes in six month time period to undergo investigation for nasopharyngeal or eustachian tube pathology
Persistent hearing loss fallowing AOM
Chronic TM perforation (> 6 weeks)
What are some complications of acute otitis media?
Mastoiditis Labyrinthitis Facial paralysis Hearing loss Petrositis Otitic meningitis Epidural, subdural and brain abscess Otitic hydrocephalus Septic lateral sinus thrombosis
