Paeds ENT Flashcards
What is acute otitis media?
Acute bacterial infection of middle ear fluid
What is otitis media with effusion?
Middle ear fluid that is not infected
Frequently precede AOM or follows its resolution
What is acute suppurative otitis media?
complication of AOM: perforation of the tympanic membrane with mucopurulent discharge.
What are 4 symptoms of acute otitis media?
Ear pain/ rubbing
Hearing loss
Ear discharge
Fever
What non-specific symptoms may arise in infants with acute otitis media?
Fever
Fussiness
Disturbed or restless sleep
Poor feeding/anorexia
D+V
When is the peak incidence of acute otitis media?
1-5y
Give 4 intrinsic risk factors for acute otitis media
Age <4y: Most occur between 6-24m
Atopic predisposition
Immunosuppression
Conditions affecting ciliary motility: CF, Primary ciliary dyskinesia + Kartagener’s syndrome
Give 4 extrinsic risk factors for acute otitis media
Passive smoking
Not receiving pneumococcal vaccination
Nursery
Bottle feeding
What is the pathophysiology of acute otitis media?
Secondary to oedema + narrowing of the eustachian tube.
Prevents middle ear from draining, predisposing it to the colonisation of bacteria.
+ Can’t equalise pressure in the middle ear
What is the most common cause of hearing impairment in children?
Acute otitis media with effusion
What is glue ear?
Chronic otitis media with effusion
Characterised by build up of fluid behind an intact TM.
>3/12 duration
What is chronic suppurative otitis media?
> 2w discharge
Discharge through perforated tympanic membrane (TM).
What 4 features may be seen on otoscopy in otitis media?
Bulging tympanic membrane → loss of light reflex
Opacification or erythema of tympanic membrane
Perforation with purulent otorrhoea
Decreased mobility if using a pneumatic otoscope
What indicates diagnosis of acute otitis media?
Bulging of the tympanic membrane- white/ pale yellow
Pus may be seen behind TM
Perforation with purulent otorrhea or bullae
What indicates diagnosis of otitis media with effusion?
TM may be retracted/ neutral position
Amber, gray, or blue
Bubbles or air-fluid level may be seen behind TM
What is the management for acute otitis media?
Analgesics
Self limiting: 3-7d
Abx don’t make much difference
In which patients with AOM are antibiotics prescribed?
<2s with bilateral OM
<3/12 with a temp > 38ºC
OM with ear discharge
Systemically unwell
Those at high risk of complication
Which antibiotics are used in acute otitis media?
1: amoxicillin
2: co-amoxiclav
What is the management for otitis media with effusion?
self-limiting disease with 50% of cases resolving in 3/12
Watchful waiting for 3/12 with Valsalva manoeuvre.
Grommets +/- adenoidectomy: if hearing loss is present for >3/12, language is delayed, there are craniofacial abnormalities or hx of recurrent AOM with OME.
Give 4 complications of AOM
Acute mastoiditis
Sensorineural + conductive hearing loss
Facial nerve palsy
Bacterial meningitis
What is acute mastoiditis?
rare complication of AOM where continued inflammation of the mucosa of the middle ear + mastoid leads to a mastoid abscess.
What are 4 signs and symptoms of acute mastoiditis?
mastoid pain + tenderness
Post-auricular inflammation: tender boggy, erythematous, fluctuant
Auricle proptosis (abnormal protrusion of the pinna).
What is management for acute mastoiditis?
IV Abx + fluid resus
Analgesia + antipyrexial agents
CT temporal bone + brain
If failure to improve may require surgical intervention by incision + drainage +/- cortical mastoidectomy +/- grommets
What is otitis externa?
Inflammation of external ear canal, may also involve the pinna or TM
What are the 2 durations of otitis externa?
Acute: <3w
Chronic: >3w
What is malignant otitis externa?
when the infection spreads to the mastoid + temporal bones causing osteomyelitis
(NOT neoplastic)
Give the 2 most common causes of otitis externa
Pseudomonas Aeruginosa
Staphylococcus Aureus
Give 4 symptoms of otitis externa
Pain
Itching
Discharge
Hearing loss
What are the 2 subtypes of otitis externa?
Localised folliculitis: can progress to a boil in the ear canal
Diffuse (aka swimmer’s ear), with widespread inflammation of skin/ subdermis
When is the peak incidence of otitis externa?
7-12y
Describe general management of otitis externa (5)
Analgesia
Avoid getting ear wet use a cap for showering + swimming
Remove any discharge by gently using cotton wool, DO NOT put cotton buds into the ear
Remove any hearing aids + earrings
What is prescribed for otitis externa?
Ciprofloxacin 0.3% w/v (eye drops used in the ear) TOP 5 drops BD 1-2w
What investigation should be performed if a child has a long standing hearing problem and no otalgia?
Pure tone audiometry
