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10 Cards in this Set
- Front
- Back
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Etiology of Acute OM
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Fluid in middle ear associated with acute local or systemic illness
Prior infection or allergy resulting in edema or congestion of mucosa of nasopharynx, Eustachian tube, and middle ear With Eustachian tube congested impedes flow of secretions of middle ear Negative pressure increases and pulls fluid to middle ear |
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Common pathogens resulting in AOM
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Strep. pneumoniae, H. influenzae, M. catarrhalis, Viruses, and other bacteria like S. pyogenes and S. aureus.
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Predisposing factors for AOM
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passive and active smoking, White or Native American race, male gender, congenital disorders like cleft palate and trisomy 21, and family hx of OM, daycare attendance
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what to ask for history in suspected AOM
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Determine onset and duration of symptoms
Ask about pain, fever, irritability Any hearing loss, tinnitus, and dizziness Any drainage Any associated S/S History of allergies |
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PE findings with AOM
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Visualize TM
Watch child’s behavior Palpate external ear—no pain with AOM to external ear but with OME or cellulitis there is external pain and painful swelling and redness over mastoid process is sign of mastoiditis Canals inspected as you go in for cerumen, discharge, infection, and smell any discharge TM should look normal—pearly gray, translucent Fluid increases start to be visible in periphery and then as pressure increases more central Retraction is associated with negative pressure or post-inflammatory adhesions Distorted light reflex suggestive of AOM Must be presence of fluid in middle ear |
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Myringitis
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red inflamed TM w/o effusion
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Bullous myringitis
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painful small or large blisters on TM caused by bacterial OM
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Adult with ear pain and TM normal look at
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Head and Neck for:
Dental Disorders TMJ Disorders Nose and Pharynx Ca Intracranial Neoplasms |
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tests for AOM
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Perform Pneumatic Otoscopy with large speculum for mobility of TM
-Acute OM inhibits mobility -Retraction of TM from negative pressure does not move and has rebound mobility when bulb is released Test hearing acuity Then examine related body systems: the head and neck, nose, sinuses, pharynx, teeth and gums as well as buccal mucosa I usually add lungs and heart Check for referred pain/ CN V, VII, IX |
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Differential Diagnosis
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OM ExternaTrauma
Cervical Lymphadenitis Referred Pain from CNs 2 and 3 Referred Pain from CNs 5,7,10,11 TMJ Disorder Furuncle Mumps Serous OM Cholesteatoma Mastoiditis Foreign Body Cerumen Impaction Barotrauma Dental abscesses Tonsillitis |
