otitis media Flashcards
in which age group is acute otitis media extremely common in?
young children, around 1/2 of children having 3 or more episodes by the age of 3 years
what is the pathophysiology of acute otitis media?
- most infections are 2˚ to bacteria: strep pneumoniae, haemophilus influenzae, moraxella catarrhalis
- viral URTIs are thought to disturb normal nasopharyngeal microbiome → allowing bacteria to infect middle ear via Eustachian tube
what are the features of otitis media?
otalgia + tug/rub ear
- fever (50%)
- hearing loss
- recent viral URTI sx
- ear d/c if TM perforates
what are the possible otoscopy findings of otitis media?
- bulging TM → loss of light reflex
- opacification / erythema of TM
- perforation with purulent otorrhoea
- decreased mobility if using pneumatic otoscope
what are the criteria used to diagnose otitis media?
-
acute onset of sx
- otalgia / ear tugging
-
presence of middle ear effusion
- bulging of TM
- otorrhoea
- decreased mobility on pneumatic otoscopy
-
inflammation of TM
- erythema
how is acute otitis media managed?
self-limiting condition, does not require abx prescription (however there are some exceptions)
- analgesia to relieve otalgia
- seek medical help if sx worsen / do not improve after 3 days
when should abx be prescribed for acute otitis media?
- sx lasting more than 4 days / not improving
- systematically unwell but not requiring admission
- immunocompromised / high risk of complications 2˚ to signifcant lung, kidney, liver or neuromuscular disease
- younger than 2 years with bilateral otitis media
- otitis media with perforation +/- discharge in the canal
if you decide to rx with abx, what abx is given for acute otitis media?
5-7 day course of amoxiillin (first-line)
what abx is given if pt has a penicillin allergy?
erythromycin or clarithromycin
what are the sequelae for otitis media?
-
perforation of TM → otorrhoea
- unresolved acute OM with perforation may develop into chronic suppurative OM (CSOM)
- CSOM = perforation of TM with otorrhoea > 6 wks
- hearing loss
- labyrinthitis
what are the complications of acute otitis media?
- mastoiditis
- menigitis
- brain abscess
- facial nerve paralysis