Otitis Media (OM) Flashcards
Background
Infection of the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum.
More common in 15 months - 6 yrs
2 main types:
Otitis Media with Effusion (OME) Acute Otitis Media (AOM)
Infection like cold occurs = mucus build up in mid ear- mucus unable to drain = infection in mid ear. Enlarged adenoid (soft tissue back of throat) can also block E tubes.
Children eustachian tube smaller and larger adenoids - making it more common in kids.
Cleft palate, down syndrome increase risk too.
Signs and Symptoms
OME- thick and sticky fluid (non-infected) accumulates behind the tympanic membrane in the middle ear. This fluid can build up as a result of a sore throat, cold or URTI which can = Eustachian tube to become blocked, more common in children. Also called glue ear.
- Tinnitus
- aural discharge
- Snoring
- Behavioural issues children
AOM- inflammation of the middle ear with effusion and infection is present. The symptoms often develop quickly.
Other symptoms for both types:
* Earache and /or fever.
* Sense of being unwell and lacking energy.
* Slight hearing loss – if the middle ear becomes filled with fluid, hearing loss may = OME.
* Possible perforated eardrum and pus may run out of the ear.
- Young - Holding, tugging, rubbing ear, cough, poor feeding, restlessness
Diagnosis/ Assessment/ Risk factors
OME:
Detailed history (symptoms socrates etc), Assess hearing loss severity, otoscope exam (normal look dont exclude OME, OME looks abnormal colour, air bubbles, fullness), AND Hearing test, tympanometry (check ear drum reaction to sound), look for risk factors (Eczema, asthma, conjunctivitis, adenoid hypertrophy)
AOM:
Look for acute onset of symptoms, Otoscope (red, yellow, or cloudy T membrane, Bulging, perforation), Check no other cause,
Risk factors - Young, Male, Family Hx, Formula feed, smoking/passive, dummy use, etc
Treatment
OME:
Children with OME NO hearing loss = self limiting - no treatment needed.
OME with hearing loss = REFER
Non surgical treatments:
- Monitoring and support
- Hearing aids (if hearing loss)
Surgical options:
- Myringotomy (create a hole in the eardrum =allow fluid that is trapped in mid ear to drain)
- Grommets - help drain fluid from eustachian tube. (grommet will fall out itself). periodically reassess. Be alert of complications of grommets. IF OTORRHOEA occurs after insert consider ciprofloxacin ear drops 5-7 days - if persists consider grommet removal.
MEDS NO EVIDENCE TO SHOW THEY HELP
AOM:
Self limiting (symptoms go in 3-7 days 3-5 in pack). Usually no treatment given.
Pain/Fever treated with paracetamol or ibuprofen.
Can use Ear drop with anaesthetic + analgesic - phenazone + lidocaine IF no antibiotic given and no eardrum perforation.
IF SYSTEMATICALLY UNWELL or high risk of complications (organ disease) immunosuppression, CF, or born premature = IMMEDIATE ANTIBIOTIC.
Consider antibiotics if <2yrs with bilateral or otorrhoea.
SEVERE systemic infection or acute complications REFER TO hospital.
Recurrent also refer
ANTIBITOICS (5-7 DAY COURSE)
NO penicillin allergy:
1st line - amoxicillin
ALT (worsening symptoms after 2-3 days of treatment) CO- amoxiclav
Penicillin allergy :
1st line - clarithromycin or erythromycin (in pregnancy).
ALT (same reason) CONSULT local microbiologist
Preventative treatment
- Keep child up-to-date vaccinations.
- Avoid child exposure to smoky environments (passive smoking).
- Not giving the child a dummy once they >6 -12 months (sucking can increase chance of blocking Eustachian tube).
- Not feed your child while they’re lying flat on their back (can cause milk to flow from throat into the eustachian tube).
- Breast milk>formula milk.
- Avoiding contact with other children who are infected
Complications
OME:
Conductive hearing loss.
Speech and language development issues, and communication skills difficulties.
Chronic damage to the tympanic membrane.
AOM:
Persistent OME.
Recurrence of infection.
Hearing loss (usually conductive and temporary).
Tympanic membrane perforation.
Labyrinthitis :- infection in the mid ear can spread into inner ear and affect delicate structure deep inside the ear called the labyrinth.
- SYMPTOMS: dizziness, vertigo (the feeling that you, or the environment around you, is moving or spinning), loss of balance, hearing loss.
- Treatment - Symptoms pass within few weeks - can get meds to relieve symptoms/treat underlying condition.
RARE:
Mastoiditis- infection spreads out of the mid ear and into the area of bone under the ear (the mastoids) - SYMPTOMS: Fever, Swelling behind ear, which pushes it forward, Redness and tenderness or pain behind ear, Creamy discharge from ear, Headache, Hearing loss.
- TREATMENT: Hospital IV antibiotics, sometimes surgery to drain ear and remove mastoid. NO tenderness mastoid excluded.
Cholesteatoma (type of cyst)- an abnormal collection of skin cells inside the ear. Cann sometimes develop BC of recurring or persistent mid ear infections. Not treated, can eventually damage the delicate structures deep inside the ear, eg bones needed for hearing. SYMPTOMS: hearing loss, weakness in half the face, dizziness, tinnitus.
Most cases, surgery needed to remove a cholesteatoma.
Facial paralysis
Very rare cases- Swelling with OM can cause the facial nerve to become compressed. The facial nerve is a section of nerve that runs through the skull and is used by the brain to control facial expressions. Compression of nerve can = person being unable to move some or all of their face. Can seem like stroke. Condition usually resolves once the underlying infection has passed and rarely causes any long-term problems.
Meningitis- Very rare and serious. Can occur if the infection spreads to the protective outer layer of the brain and spinal cord (the meninges). SYMPTOMS: Severe headache, vomiting, fever, stiff neck, photophobia, rapid breathing, a blotchy red rash that does not fade or change colour when you place a glass against it (not always present).
SUS = Immediately go A&E or call 999. Meningitis caused by a bacterial infection. Treated in hospital with IV antibiotics.
Brain abscess- Very rare but serious complication. This is a pus-filled swelling that develops inside the brain. SYMPTOMS: Severe headache, changes in mental state, weakness or paralysis on one side of the body, fever, seizures.
Medical emergency. usually treated with combo of antibiotics and surgery. The surgeon will usually open the skull and drain the pus from the abscess or remove the abscess entirely.
