Otitis Media & Otitis Externa Flashcards
signs and symptoms of AOM
- otalgia (earache)
- irritability
- fever
- bulging of the typanic membrane
- limited or absence of movement of TM
- air-fluid level behing TM/bubbles
- otorrhea if TM is ruptured
- erythema of TM
Most common cause of pediatrician visits in the US? Can be recurrent or chronic
otitis media
risk factors for otitis media?
cleft palate
genetic predisposition- Down’s syndrome
lower socioeconomic status
premature birth
siblings
daycare attendance
secondhand smoke expousre
lack of breasfeeding in first 6 months
diagnosis of AOM?
Acute onset of symptoms
presence of middle ear effusion
middle ear inflammation
clinical history of ear pulling, fever, irritability is non-specific
pneumatic otoscopy
what pathogens are common causes of otitis media?
- S. pneumoniae most common (pneumococcal vaccine has altered certain serotypes)
- H. Influenzae and M. cattarhalis are other most common
- virues are also significant contributor: RSV, rhinovirus, coronavirus, parainfluenza, adenovirus
Treatment for AOM
- watchful waiting if less than 48-72hrs and mild symptoms
- 1st line- Amoxicillin 80-90mg/kg/day divided BID or TID
- 2nd line- if no improvement- Augmentin or cefdinir
- penicillin allergic- azithromycin, clindamycin
treatment of recurrent AOM
repeat antibiotics
tympanpstomy tubes
- keratin debris (skin) where it shouldnt be (middle ear; mastoid)
- congenital versus acquired (tubes, trauma)
- destructive to surrounding bone, ossicles, vestibules
- chronic or recurrent acute otitis media, hearing loss, dizziness, tinnitus (ringing) drainage
Cholesteatoma
What are the indications for tympanostomy?
- > 3 AOM in 6 months, >4 in 12 monts with at least one middle ear effusion at evaluation
- chronic otitis media with hearing loss
follow-up 1-3 months w/audiogram
complications of Otitis Media?
- hearing loss
- cholesteatoma
- typanic membrane perforation
- mastoiditis
- occurs in most cases of acute otitis media and chronic otitis media
- middle ear effusion decreases tympanic membrane compliance (generallly improves as effusion resolves
- erosion of ossicular chain in chronic otitis media (does not improve with resolution of effusion)
Conductive hearing loss
Sensorineural hearing loss is extremely uncommon
Treatment of cholesteatoma?
- Surgery (canal wall up mastoidectomy, canal wall down mastoidectomy) will need mastoid cleaning for life and water precautions.
- 2nd look procedure at 6-12 months for post op with possible ossicular chain reconstruction
- recurrence very common
- follow up: 1 week, 1 month and 3 months
treatment of tympanic membrane perforation?
- watchful waiting: many small perforations heal spontaneously
- allow 6 months, if not healed at this time, likely will not close
- monitor perforation every 6 months- ensure no cholesteatoma, worsening ear loss
- hearing aid for amplification
- surgically repair- tympanoplasty/myringoplasty
- postauricular erythema
- mastoid tenderness
- auricular protrusion
- fullness or blunting of postauricular sulcus
- elevated WBC count
- systemic toxicity (fevers, lethargy)
mastoiditis
treatment of mastoiditis?
- IV antibiotics
- myringotomy and tube placement with or without mastoidectomy pending radiographic findings (subperiosteal abscess, spread beyond mastoid–> intracranial etc.)
