otitis media Flashcards

1
Q

in which age group is acute otitis media extremely common in?

A

young children, around 1/2 of children having 3 or more episodes by the age of 3 years

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2
Q

what is the pathophysiology of acute otitis media?

A
  • 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
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3
Q

what are the features of otitis media?

A

otalgia + tug/rub ear

  • fever (50%)
  • hearing loss
  • recent viral URTI sx
  • ear d/c if TM perforates
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4
Q

what are the possible otoscopy findings of otitis media?

A
  1. bulging TM → loss of light reflex
  2. opacification / erythema of TM
  3. perforation with purulent otorrhoea
  4. decreased mobility if using pneumatic otoscope
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5
Q

what are the criteria used to diagnose otitis media?

A
  1. acute onset of sx
    • otalgia / ear tugging
  2. presence of middle ear effusion
    • bulging of TM
    • otorrhoea
    • decreased mobility on pneumatic otoscopy
  3. inflammation of TM
    • erythema
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6
Q

how is acute otitis media managed?

A

self-limiting condition, does not require abx prescription (however there are some exceptions)

  1. analgesia to relieve otalgia
  2. seek medical help if sx worsen / do not improve after 3 days
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7
Q

when should abx be prescribed for acute otitis media?

A
  1. sx lasting more than 4 days / not improving
  2. systematically unwell but not requiring admission
  3. immunocompromised / high risk of complications 2˚ to signifcant lung, kidney, liver or neuromuscular disease
  4. younger than 2 years with bilateral otitis media
  5. otitis media with perforation +/- discharge in the canal
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8
Q

if you decide to rx with abx, what abx is given for acute otitis media?

A

5-7 day course of amoxiillin (first-line)

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9
Q

what abx is given if pt has a penicillin allergy?

A

erythromycin or clarithromycin

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10
Q

what are the sequelae for otitis media?

A
  1. perforation of TM → otorrhoea
    • unresolved acute OM with perforation may develop into chronic suppurative OM (CSOM)
    • CSOM = perforation of TM with otorrhoea > 6 wks
  2. hearing loss
  3. labyrinthitis
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11
Q

what are the complications of acute otitis media?

A
  1. mastoiditis
  2. menigitis
  3. brain abscess
  4. facial nerve paralysis
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