Otitis Media

Question 1

What is otitis media with effusion?

Answer 1

Fluid accumulation in the middle ear due to the eustachian tube becomes swollen and obstructed from a UTI

Question 2

What happens when OME persists for months?

Answer 2

If it persists for months, tympanostomy tubes are

sometimes inserted by an ENT physician

Question 3

What is acute otitis media?

Answer 3

when the fluid in OME becomes infected

Question 4

Where does the pathogen originate to cause AOM?

Answer 4

the nasopharynx.

Question 5

Why is AOM more likely to occur in children?

Answer 5

eustachian tube is shorter and straighter than later in life (so bacteria have an easier time getting from the nasopharynx into the middle ear)

More likely to have the bacteria that cause acute otitis media in the nasopharynx (older children have antibodies to more strains of the bacteria that cause acute otitis media, so are less likely to be colonized)

Question 6

T or F: bottle fed children are at higher risk of AOM

Answer 6

T

Question 7

Who is at higher risk of AOM?

Answer 7

bottle fed, smoke exposure [induces chronic inflammation], Cleft lip/palate also causes chronic inflammation (also causes chronic inflammation)

Question 8

What is the prognosis of AOM?

Answer 8

painful for first few days –> self-limiting; sometimes tympanic membrane is perforated and discharge of pus

Question 9

T or F: cold usually coincides with AOM

Answer 9

T

Question 10

What are symptoms of AOM?

Answer 10

symptoms of cold
intermittent earache
sometimes fever
temp. hearing loss

Question 11

What are signs of AOM?

Answer 11

children usually irritable
pulling of the ear
drainage of pus from the ear

Question 12

What should you be looking for with a othoscope in AOM?

Answer 12

• pus behind ear drum
• redness of eardrum [viral origin]
• cannot see cone of light, and MIS ossicles
• perforated membrane

Question 13

T or F: In other words, acute otitis media is always
preceded and followed by otitis media with
effusion.

Answer 13

T

Question 14

What is a complication of AOM?

Answer 14

In a very small percentage of patients, the infection can
spread to involve the mastoid bone (resulting in
mastoiditis).

rarely spreads to the brain –> meningitis and facial nerve palsy

Question 15

What to do to look for mastoid infection with AOM?

Answer 15

Always palpate the mastoid for tenderness and look for a displaced pinna (pushed forward by an infected mastoid)

Question 16

T or F: Antibiotics do prevent the development of
or shorten the duration of otitis media with
effusion (OME).

Answer 16

FL they do not prevent

Question 17

What is the treatment for AOM?

Answer 17

Children 6 months of age or older with no
underlying chronic illness who have non
severe otalgia and a temperature <
39 degrees C should be treated with
analgesics. If they do not improve after 48
hours, then antibiotics [that do not respond to amoxicillin] should be started for 5 - 10 days [younger longer].

Question 18

What might be reasons why amoxicilin fails to cure AOM?

Answer 18

1. Incorrect diagnosis
2. Penicillin resistant pneumococci
3. Beta lactamase producing strain of H.
   influenzae or M. catarrhalis (Usually AOM
   with these strains resolves even with no
   antibiotics but this does not always occur)
4. Poor compliance in taking the amoxicillin

Question 19

What should be the next antibiotic if AOM persists after amoxicilin?

Answer 19

Adding clavulanate to amoxicillin allows it to
overcome the beta lactamase produced by H.
influenzae and M. catarrhalis .

Therefore, a good option is to change to
amoxicillin clavulanate (Clavulin).

Question 20

Who should get tympanostomy tubes ?

Answer 20

should only be considered if the child is having more

than 3 episodes of acute otitis media within 6 months, or more than 4 episodes within 12 months.