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36 Cards in this Set

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Define duration of acute otitis media
0-3 weeks
Define duration of subacute otitis media
3-12 weeks
Define duration of chronic otitis media
longer than 12 weeks
Define recurrent acute otitis media (AOM)
four or more episodes of acute OM in 1 year or three or more episodes in a 6-month period
What can cause otitis media with effusion?
postinflammatory response to AOM, from a viral infection, or because of eustachian-tube dysfunction
Define chronic suppurative otitis media (CSOM):
persistence of purulent otorrhea through a tympanic membrane (TM) perforation or tympanostomy tube (TT) that is unresponsive to medical therapy
Why is the onset of AOM during the first year of life important?
majority of children with multiple recurrences of AOM have their first episode before the age of 12 months
What % of children have OME in the first year of life?
More than 50% of children experience OME in the first year of life
What factors predispose children to otitis media?
Genetics, crowded households, low socioeconomic status, day care, decreased breast feeding, exposure to second hand smoke
What are some immunodeficiencies that can make children more susceptible to otitis media?
hypogammaglobulinemia, IgA deficiency, DiGeorge syndrome, HIV, drug induced immunodeficiency (steroids, chemotherapy)
What conditions are associated with and increased incidence of otitis media?
allergy, sinusitis, adenoid hypertrophy, prolonged nasal intubation, NG tube, possibly gastroesophageal reflux
Is there data supporting antihistamine/decongestant in treating otitis media with effusion?
No
Dysfunction of what organ is the cornerstone in the pathogenesis of otitis media?
Eustacian tube
How doe the eustacian tube in infants and children compare to adults?
Shorter, more horizontal (10 degrees vs. 45) and functionally less mature
What are the commonly identified aerobic pathogens associated with acute otitis media?
Streptococcus pneumoniae, nontypable H. Influenzae and Moraxella catarrhalis.
What gram negative bacteria are consistently isolated in a small propotion of patients with acute otitis media?
E. Coli, Klebsiella and Pseudomonas aeruginosa
How common is fever in acute otitis media?
2/3 of children will have fever, but over 40 celcius is uncommon
What are the common symptoms of acute otitis media?
fever, irritability, otalgia, anorexia, nausea, headache, hearing loss
Why do AOM symptoms appear worse at night or during naps?
Eustacian tube is less functional when lying down
What are middle ear landmarks that can been seen through a normal TM?
Short process of the malleus, incudostapedial joint, chorda tympani
What is one of the most common causes of a failure of otoacoustic emission recording?
Middle ear effusion
What is the method of choice in distinguishing sensorineural from conductive hearing loss in infants younger than 6 months?
Auditory brainstem response
What kind of audiometry is recommended for infants 6 months to 1 year?
Behavioral observation audiometry
What kind of audiometry is recommended for children 1 to 2 years?
Visual reinforcement audiometry
What kind of audiometry is recommended for children older than 2
Play audiometry
What can play audiometry tell you that behavioral reinforcement or visual reinforcement audiometry can not?
It is ear speceific AND can distinguish between sensorineural and conductive hearing losses
What is acoustic reflectometry?
Measures the total level of reflected and transmitted sound
What is the spontaneous resolution rate of acute otitis media?
60% within 24 hours, 80% 2-3 days
What are reasons for spontaneous resolution of AOM?
1. Drainage of effusion down eustacian tube
2. Drainage thru perforated TM
3. Local or systemic immune response
4. viral or non-infectious process
5. incorrect diagnosis
When might it be appropriate to observe AOM with only pain management?
1. Healthy children 6 months to 2 years with nonsevere symptoms AND uncertain diagnosis
2. Children 2-12 who have nonsevere symptoms OR uncertain diagnosis
How should you manage the child with Otitis media with effusion who is not at risk?
Watchful waiting for 3 months from date or onset or diagnosis
If surgery for Otitis media with effusion is inducated what should be performed?
Tympanostomy tubes should be the initial procedure - Repeated surgery should consisted of adenoidectomy with myringotomy and possible tube insertion
When are ventilation tubes the treatment of choice?
1. Recurrent AOM unresponsive to medical therapy
2. Chronic otitis media with persistent effusion for 3 months and conductive hearing loss
3. Negative middle ear pressure with impending cholesteotoma
4. Intervention in the presence of complications of otitis media
What are complications of tympanostomy tubes?
1. Otorrhea
2. Persistent TM perforation
3. Scarring/tympanosclerosis
4. Plugging of the tube
5. Formation of granulation tissue around the tube
6. Atrophic or thinned areas of the TM
7. Early extrusio/extrusion into the middle ear
8. Cholesteotoma
What are Intratemporal complications of otitis media?
INTRATEMPORAL
1. Hearing loss (conductive and sensorineural)
2. TM peforation
3. Chronic suppurative OM
4. Retraction pocket/atelectasis
5. Cholesteotoma
6. Tympanosclerosis
7. Ossicular discontinuity/fixation
8. Mastoiditis
9. Labyrinthitis
10. Facial paresis/paralysis
11. Cholesterol granuloma
12. Infectious eczematoid dermatitis
What are intracranial compliations of otitis media?
INTRACRANIAL
1. Meningitis
2. Subdural empyema
3. Brain abscess
4. Extradural abscess
5. Lateral sinus thrombosis
6. Otitic hydrocephalus