Otitis Media & Externa - 5Qs Flashcards
Define Acute Otitis Media (AOM).
RAPID onset, symptomatic infection of middle ear with MEE
Define recurrent AOM.
6 episodes of AOM over 12 months
Define OME.
OME with duration of > 3 months
When does acute bacterial inf occur?
Acute bacterial infection usually follows viral upper respiratory tract infection.
List non-modifiable risk factors
< 2 year Family members with respiratory infection Genetic predisposition Eustachian tube anatomy Premature birth Male gender Immunodeficiency Family hx of recurrent otitis media Siblings in the household Low socioeconomic status
List modifiable risk factors
Daycare attendance Breast feeding v.bottle feeding Breast feeding < 3 months Supine bottle feeding position Pacifier use from 6months to 1year Exposure to parental smoking or secondhand smoke
List the most common bacterial pathogens
Streptococcus Pnuemoniae
Haemophilus Influenzae
Moraxella catarrhallis
List the other bacterial pathogens that cuz OM
S. aureus
Gram-negative bacilli
List the viral pathogens that cuz OM
RSVP Parainfluenza viruses Influenza viruses Rhinovirus Coronavirus Adenovirus Enterovirus
Name clinical presentation of AOM
Bulging, cloudy, immobile and/ or red Tympanic Membrane (TM)
Otalgia, ear pulling, and otorrhea
Name non-specific clinical presentation of AOM (mimics URT)
Fever Rhinitis Irritability Cough Congestion Poor appetite Vomiting
List the 3 criteria used to diagnose AOM
ACUTE onset of s/sx MEE (at least 1 of the ff) -bulging TM -decreased/ absent motility of TM -otorrhea Middle ear inflammation (at least 1 of the ff) -red TM -otalgia affecting normal activity and/or sleep
How’s AOM diagnosed?
Via Otoscopy and tympanometry
How do you treat ear pain?
Usually self-limiting
May consider analgesic regardless of AB use e.g. Oral acetaminophen, ibuprofen, topical analgesic ear drops
Avoid topical ear drops if perforated ear drum or otorrhea
What possible complications may result from AOM (usually why tx is done, to avoid these complications)
Mastoiditis
Meningitis
Intracranial abscess formation
Hearing, speech or language impairment
What’s the evidence based tx guideline for < 6months (certain v. uncertain diagnosis)
AB for both cases
What’s the evidence based tx guideline for 6months to 2 yrs (certain v. uncertain diagnosis).
Certain diagnosis - AB
Uncertain diagnosis - AB, if severe
Observation, if not severe
What’s the evidence based tx guideline for >2yrs (certain v. uncertain diagnosis)
Certain diagnosis - AB, if severe
Observation, if not severe
Uncertain diagnosis - Observation option
What’s the 1st line tx for AOM
Amoxicillin
0-2yrs x 10 days
> 2 yrs x 5-7 days
What’s the option for resistant/recurrent b-lactamase producers?
Amoxicillin / Clavulanate acid (augmentin)
When do you consider using the alternative therapy?
- Sx worsens / doesn’t improve 48-72h after starting amoxicillin
- Recurrence of AOM <2 yrs of age
- Culture shows resistance pathogen
- Penicillin allergy
Name the AB of choice for penicillin-allergic (non-type1) inf
Cephalosporin
- Cefdinir
- Cefprozil
- Cefuroxime
- Cefpodoxime
Which of the penicillin-allergic (non-type 1) alternatives is equivalent to Augmentin?
Cefprozil
Which cephalosporin is used of nausea/vomiting or tx failure happens?
Ceftriaxone
Name the options for penicillin- allergenic (type 1)
Azithromycin
Clarithromycin
Clindamycin
Which ones can’t be used for children < 6 months?
Azithromycin
Clarithromycin
Which AB is the option for PCN-resistant pneumococcal inf?
Clindamycin
What tx is NOT recommended for AOM?
Prolonged/prophylactic AB Steroids Antihistamine (becuz allergies don't cuz AOM) Decongestants CAM
What inf is common and may take weeks to months to resolve?
MEE
What’s the relationship btw vaccination and AOM.?
Vaccination may reduce the incidence of AOM
What are the benefits of Tympanostomy tubes?
- reduce recurrent AOM
- reduce amt of time with effusions
- maximize hearing potential for at risk children
- prevent chronic changes to TM or middle ear space
- prevent/treat acute complications of AOM
Definite AOE
-Diffuse inflammation of external ear canal, possibly involving the pinna or TM
Also known as “Swimmer’s ear” or “Tropical ear”
What’s the payhophysiology of AOE?
Normal protective layer of cerumen becomes altered
Exposure to bacteria is easier, and this occurs usually through water exposure
Name risk factors for AOE
Freq removal or alteration of cerumen Chronic dermatological condition Local trauma Warmer, more humid climate Increased water exposure genetics Allergy Sweating
Name clinical presentation of AOE
Redness and inflammation of external ear Variable edema and otalgia Pruritis Diff sleeping Mild to mod hearing impairment Exudative discharge
Name the primary pathogens that are responsible for AOE
P. aeruginosa
S. aureus
T4 it’s a mainly bacterial inf
Name atypical causes of AOE
Aspergillus sp
Candida sp
Immunocompromised pts - diabetes, HIV etc
What’s the preferred tx for AOE.
Topical therapy
Ciprofloxacin + dexamethasone
Ciprofloxacin + hydrocortisone
What is oral AB for AOE?
Fluoroquinolones are the only effective PO AB for AOE
In what pt population is systemic tx considered, either alone or with topical therapy?
- Diabetics
- AIDS/HIV
- AOE that has spread to the skin of the neck and face
- Malignant externa otitis
- AOE complicated by osteomyelitis, abscess formation or middle ear dx
- Recurrent episode of AOE
