Revision - Otitis Media & Tonsillitis Flashcards
What age is a risk factor for otitis media?
<4 y/o
What 2 genetic disorders can predispose to otitis media?
1) Primary ciliary dyskinesia
2) Kartagener’s syndrome
Lack of what vaccination can contribute to development of otitis media?
Pneumococcal
Is bottle or breastfeeding a risk factor for otitis media?
Bottle feeding
Give the 4 most common bacteria causing otitis media
1) Strep. pneumoniae
2) Haemophilus influenzae
3) Moraxella catarrhalis
4) Staph. aureus
What is the most common cause of hearing impairment in children?
Otitis media w/ effusion
What are the 2 types of chronic OM?
1) Chronic OM with effusion (‘glue ear’)
2) Chronic suppurative
How long must OM be present for to support a diagnosis of ‘chronic’?
> 3 months
Is acute or chronic OM with effusion more likely to cause hearing impairment?
Chronic
What is chronic suppurative OM?
Presents with persistent ear discharge through a perforated tympanic membrane (TM).
How long must discharge be present for in chronic suppurative OM to support a diagnosis?
> 2 weeks
What is often the management of acute OM?
Most cases of OM will self resolve without antibiotics and instead use simple analgesia.
When are Abx considered in OM?
A prescription for antibiotics may be given with the advice to take:
a) in 3 days if symptoms do not being to improve
b) or the patient becomes systemically unwell
Which groups is it recommended to prescribe Abx?
1) children <2 y/o with bilateral OM
2) children <3m with temp >38
3) OM with ear discharge (otorrhoea)
4) systemically unwell
5) high risk of complications
1st line abx in OM?
Amoxicillin (5-7d)
2nd line abx in OM?
Erythromycin or clarithromycin
Management of acute and chronic otitis media with effusion (glue ear)?
1) Conservative management & observation for 6-12 weeks
2) Pure tone audiometry
3) Referral to 2ary care if:
- There is concern with the child’s development
- The hearing loss persists after other symptoms have resolved
- There is severe hearing loss
- The child has Down’s syndrome or cleft palate
In what 2 conditions would you refer to 2ary care in chronic OM with effusion (glue ear)?
1) Down’s sydnrome
2) Cleft palate
Management options in 2ary care of chronic otitis media with effusion (glue ear)?
1) hearing aids –> offered to patients with persistent bilateral symptoms
2) Eustachian tube autoinflation –> blowing up a balloon with the nostrils several times a day
3) Surgical –> myringotomy with grommet insertion
How long are grommets usually in for?
They are ordinarily a temporary measure lasting around 12 months.
Perforations in what area of TM are more likely to lead to mastoiditis?
Upper portion of drum
What is mastoiditis usually the result of?
Infection of the middle ear –> OM
It most commonly occurs in children of school age following an UNTREATED episode of acute otitis media or after RECURRENT episodes of otitis media.
What are the most common pathogen causing OM/mastoiditis in young children prior to vaccination?
Haemophilus influenzar
What are the most common pathogen causing OM/mastoiditis in children of school age?
Strep. pneumoniae
What pathogen can cause OM or mastoiditis in diabetics?
Pseudomonas aeruginosa
What is there often a history of in mastoiditis?
Recurrent or chronic OM
Abx of choice in mastoiditis?
1st line –> Cephalosporins e.g. ceftriaxone
If allergic to penicillins / beta-lactams –> vancomycin, gentamicin
What branch of the facial nerve runs through the middle ear?
The corda tympani branch of the facial nerve.
Risk factors for chronic suppurative OM?
poor hygiene, malnutrition, and exposure to polluted environments.
Is tonsillitis more likely to be viral or bacterial?
Viral
What tonsils are involved in tonsillitis?
Palatine tonsils
What is the most common virus causing viral tonsillitis?
Rhinovirus
3 most common viruses causing viral tonsillitis?
1) rhinovirus
2) covid
3) parainfluenza virus
What is the most common bacterial cause of tonsillitis?
GAS (S. pyogenes)
What is the 2nd most common cause of bacterial tonsillitis?
Strep. pneumoniae
What Centor score indicates it is acceptable to offer abx?
≥3
What 4 aspects make up the centor criteria?
1) fever >38
2) absence of cough
3) tender cervical lymphadenopathy
4) tonsillar exudates
Higher score = more likely to be bacterial cause
Does a cough indicate that a viral or bacterial cause of tonsillitis is more likely?
Viral
Where are the tonsillar lymph nodes located?
Just below the angle of the mandible (jaw bone)
In which circumstance are investigations done in tonsillitis?
If confirmation of group A streptococcal (GAS) infection is required e.g. immunosuppression, very old/young, severe symptoms
When it is indicated, what test is used for the confirmation of group A streptococcal (GAS) infection in tonsillitis?
1) Rapid antigen test for GAS
2) If negative –> throat culture
What Abx is indicated in tonsillitis caused by group A streptococcus (Streptococcus pyogenes)?
Penicillin V (phenoxymethylpenicillin) 10d course
Describe the FeverPAIN score
Fever >38 degrees in past 24h
P - purulence on tonsils
A - attended rapidly (<3d from symptom onset)
I - inflamed tonsils
N - no cough/coryza
What are the NICE indications for Abx in tonsillitis?
1) features of marked systemic upset 2ary to the acute sore throat
2) unilateral peritonsillitis
3) history of rheumatic fever
4) an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
5) patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present
What FeverPAIN score would you consider prescribing Abx? What Centor score?
Centor –> ≥3
FeverPAIN –> ≥4
1st line Abx in tonsillitis in penicillin allergy?
Clarithromycin
Complications of tonsillitis?
1) peritonsillar abscess (quinsy)
2) rheumatic fever
3) scarlet fever
4) otitis media
5) post-strep glomerulonephritis
6) post-strep reactive arthritis
What is the most common bacterial cause of a quinsy?
GAS
Management of a quinsy?
1) Refer to hospital under ENT
2) Needle aspiration OR surgical incision & drainage to remove pus
3) Abx before and after surgery
Choice of Abx in quinsy?
Co-amoxiclav (broad spectrum)
How does a cholesteatoma present?
- Recurrent ear discharge that may be foul smelling
- Hearing loss
- Pain (if there is an associated infection)
What is a 1ary (or reactionary) haemorrhage post-tonsillectomy?
most commonly occurs in the first 6-8 hours following surgery
Management of wound bleeding in the first 6-8 after tonsillectomy?
Immediate return to theatre
What is 2ary haemorrhage post-tonsillectomy?
What is it associated with?
Occurs between 5-10 days after surgery.
Often associated with wound infection.
Management of 2ary haemorrhage post-tonsillectomy?
Admission & abx
When should a child with recurrent glue ear be referred to ENT?
If they have persisting significant hearing loss on TWO separate occasions (usually 6-12 weeks apart).
management of otitis externa?
topical antibiotic or a combined topical antibiotic with a steroid
Management of acute OM with perforation?
Oral Abx (amoxicillin) for 5-7 days
What are 3 key complications of mastoiditis?
1) facial nerve palsy
2) hearing loss
3) meningitis
Inheritance of otosclerosis?
Autosomal dominant
What type of hearing loss does ototoxicity associated with medications typically cause?
Sensorineural
Immediate management of bleeding post-tonsillectomy 5 days ago?
Refer immediately to ENT –> all post-tonsillectomy haemorrhages should be assessed by ENT
What does unilateral glue ear in an adult need to be investigated for?
Posterior nasal space tumour
