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24 Cards in this Set
- Front
- Back
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What is the most common predisposing factor for acute otitis media?
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URI
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What are the risk factors for acute otitis media?
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1. URI
2. day-care attendance 3. allergies 4. enlarged adenoids 5. bottle-feeding instead of breast-feeding 6. exposure to secondary smoke 7. low SES |
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What groups have a higher incidence of OM?
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Boys and Native American children
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What is the likely pathogenesis of AOM?
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Most cases of AOM occur when nasopharyngeal pathogens enter the warm, moist middle-ear space via the eustachian tube. Eustachian tubes in children under age 6 tend to be short, narrow, and more horizontal, resulting in poor drainage and ventilation, and are easily obstructed by enlarged adenoids, nasopharyngeal irritation and/or infection, and allergies. The presence of pathogens leads to mucosal swelling in the middle ear and inflammatory obstruction of the eustachian tube. The resultant purulence and pressure usually lead to pain and fever.
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Why is there a reduced incidence of AOM in later childhood?
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As the child grows, the eustachian tube elongates and angles downward, improving drainage. In addition, the pediatric immune system is strengthened in time.
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How common is viral AOM?
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Up to 25% of of middle-ear cultures are sterile and are felt to be viral.
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What symptoms of AOM are often present in young children?
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1. Non-specific irritability
2. Crying 3. Malaise 4. Fever 5. Diminished appetite 6. Ear-pulling 7. concurrent URI 8. concurrent allergic symptoms (runny nose, congestion, conjunctival inflammation, etc.) |
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What are some less commonly associated symptoms of AOM?
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1. Purulent ear discharge (from a perforation)
2. Diarrhea 3. Vomiting |
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In older children or adults, what is the most common symptom of AOM?
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Well-localized otalgia
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What are the objective findings of AOM?
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On otoscopic examination, the TM appears red, bulging, or opacified, having decreased motility and poorly visible landmarks.
*Decreased motility of the TM appears to be more predictive than are color changes in diagnosing AOM. As OM develops, pain may precede eardrum redness. Also, many children are examined before strong clinical signs are evident, and so OM often is diagnosed and treated simply on the basis of symptomatology and suspicion. |
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Excluding AOM, what are the most common causes of otalgia?
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1. Otitis externa
2. Serous otitis media 3. Cerumen impaction/foreign body 4. Furunculosis/skin infections 5. Dental problems 6. Trauma 7. Sinusitis 8. Lymphadenitis 9. Tonsillitis/pharyngitis 10. Barotitis/pressure changes |
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What medical anomalies place children at higher risk for AOM?
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Children who are immunocompromised and those with cleft palate, hypotonia, and Down syndrome have a greater risk of OM.
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What are the initial drugs of choice in uncomplicated OM?
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Amoxicillin and trimethoprim-sulfamethoxazole (Bactrim, Septra)
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If OM fails to resolve w/ first-line antibiotics, what is suspected?
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A beta-lactamase-producing organism is suspected.
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What are the top 5 microbiologic causes of OM?
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1. Strep pneumoniae 35-40% (5% resistant)
2. Haemophilus influenzae ~25% (~50% produce beta-lactamase) 3. Moraxella catarrhalis ~15% (~90% produce beta-lactamase) 4. Strep pyogenes 5-8% (most biologically common cause of spontaneous rupture of the TM) 5. Viral: up to 25% |
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What is the most biologically common cause of spontaneous rupture of the TM?
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Streptococcus pyogenes (beta-hemolytic Group A Strep)
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How long after the initiation of antibiotic therapy should patients be asymptomatic?
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The patient should be basically asymptomatic after 2-3 days of antibiotic therapy, or an alternative medication should be considered.
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What are common second-line antibiotics for OM?
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Amoxicillin/clavulanate potassium (Augmentin) and a cephalosporin antibiotic are common next-line choices.
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What is a possible complication of chronic ear infections?
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Chronic ear infections can lead to the formation of cholesteatomas, or pockets of scar tissue and debris on the TM. Cholesteatomas can seriously damage the ossicle chain, leading to permanent hearing loss, pain, or dizziness. If suspected, refer to ENT.
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What are supportive measures for OM?
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Treat the pain; ibuprofen or acetaminophen effectively controls most pain related to OM. It's not necessary to treat simple fever. Auralgan (antipyrine and benzocaine) otic solution works well for ear pain (not for use if TM is ruptured). Fill the ear canal w/ body temp drops and insert cotton plug-repeat every 2 h if needed.
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Why should antihistamines be avoided in treatment of OM?
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Antihistamines are not recommended because of their drying effects and have limited value in allergy-complicated OM.
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What are the most common complications of OM?
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Chronicity, recurrent infections, and temporary hearing loss are among the most common complications of OM.
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What are some common antibiotics for treating AOM?
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Amoxicillin (Amoxil), Trimethoprim-sulfamethoxazole (Septra or Bactrim); Amoxicillin-clavulanate (Augmentin), Aziithromycin (Zithromax), Cefixime (Suprax)
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If a patient with OM is seriously ill or toxic-appearing, what supportive treatment is available?
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A simple myringotomy, or lancing of the TM, is a supportive treatment and a pain-relieving procedure that can be done if the patient is seriously ill or toxic-appearing.
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