Otitis media Flashcards
What is acute otitis media?
Infection of the middle ear resulting from nasopharyngeal organisms migrating through the eustachian tube
Describe how the anatomy of children’s eustachian tube makes acute otitis media more likely
Immature
short, straight and wide
Only becomes oblique as the child grows
List some common bacteria which cause acute otitis media
S.pneumoniae (most common)
H.influenza
M.catarrhalis
S.pyogenes
List some common viruses which cause acute otitis media
Respiratory syncytial virus (RSV)
Rhinovirus
List some risk factors for acute otitis media
Age (peak 6-15months) Gender (boys) Parental smoking Bottle feeding Craniofacial abnormalities
What is recurrent acute otitis media commonly associated with?
Use of pacifiers
Those fed supine
First AOM episode when <6mo
Describe the typical presenting complaint of acute otitis media in children
Pain Malaise Fever Coryzal symptoms Tugging or cradling the ear Off food Irritable Vomiting Extreme pain which suddenly resolves followed by discharge from the ear is a perforation TM
What may be seen on otoscopy in acute otitis media?
Erythematous and bulging tympanic membrane
Tear in the TM if perforated
Purulent discharge in the auditory canal if perforated
How is acute otitis media diagnosed?
Most can be diagnosed clinically
Bloods - FBC and CRP - confirm infection, blood cultures if suspecting sepsis
Swabs of discharge for MC&S
Describe how acute otitis media is managed
Majority spontaneously resolve after 1-3days
Simple analgesics
Watch and wait with delayed prescription antibiotics (if still unwell at 4 days)
If worrying features then IV antibiotics
When should oral antibiotics be considered for acute otitis media?
Systemically unwell but not requiring admission
Known RF for complications - congenital heart disease or immunosuppression
Unwell for >4days with no improvement
Discharge from the ear
Children <2yo with bilateral infections
When should inpatient admission for acute otitis media be considered?
All children <3months with temp >38
All children 3-6 months with temp >39
Evidence of AOM complication or sepsis
Cochlear implant - need to be seen by specialist
List the complications of acute otitis media
Mastoiditis Meningitis Facial nerve paresis Intracranial abscess Sigmoid sinus thrombosis Chronic otitis media
When examining a child with acute otitis media what else should be examined?
7th cranial nerve - as it runs through the middle ear
Cervical lymphadenopathy
Mastoid
Describe mastoiditis
Common Intratemporal complication of AOM
Inflammation and infection spreading to the bone of the mastoid air cells
How does mastoiditis present?
Boggy, erythematous swelling behind the ear
If left untreated may push the pinna forward
How should suspected cases of mastoiditis be managed?
Admit for IV antibiotics (co-amoxiclav or ceftriaxone), bloods (FBC, CRP), swabs for MC&S and CT head and mastoid with contrast (/MRI) if not improving after 24hrs IV antibiotics
What are the complications of mastoiditis?
Meningitis Sub-periosteal abscess Bone necrosis Facial nerve palsy Hearing loss - conductive and sensorineural Labyrinthitis Cranial osteomyelitis Dural sinus thrombosis
What is the definitive management of mastoiditis?
Mastoidectomy
What are the mastoid air cells
Collection of air filled spaces located in the mastoid process of the temporal bone
How do the mastoid air cells communicate with the middle ear?
Small canal called the aditus to mastoid antrum
Describe the formation of a sub-periosteal abscess
Infection in the mastoid air cells
Breakdown of fine trabeculae along with collection of pus in the mastoid antrum
Under pressure and results in localised bone necrosis which can spread to form the sub-periosteal abscess
Where can abscesses caused by mastoiditis be found?
Behind the pinna - Macewen’s triangle
Superior to the pinna towards the zygomatic bone
Over the squamous temporal bone
List the risk factors for mastoiditis
Young children
Immunocompromised
Pre-existing cholesteatoma
