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16 Cards in this Set

  • Front
  • Back
Otitis Media
A 4-year-old child is seen in the office with a 3-day history of fever and cold
symptoms, and now complains of right ear pain. Physical examination is remarkable
for a bulging tympanic membrane with loss of light reflex and landmarks.
Definition. Otitis media (OM) is inflammation of the middle ear.
Risk Factors/Etiology.
Risk Factors/Etiology. Infants and children are at highest risk for otitis media, with the risk
decreasing after 6 years of age.

Male sex, daycare settings, secondhand smoke, and formula feeding predispose to OM. Craniofacial anatomy and eustachian tube dysfunction are responsible for development of OM. Patients with craniofacial anomalies are also at increased risk for OM.
Streptococcus pneumoniae, 20-35%
nontypable Haemophilus injluenzae, 30%
and Moraxella
(Branhamella) catarrhalis 20%
are the most common bacterial causes of OM.
Viruses (respiratory
syncytial virus, 14% rhinovirus, influenza, adenovirus) can also cause OM, alone or as copathogens
with bacteria
Presentation.
Presentation. Typical symptoms of acute OM include otalgia, fever, irritability, and ear pulling.
Fever is seen in up to half the cases. Vomiting and diarrhea are also seen. Older children can
complain of hearing loss. Drainage from the ear is not uncommon.
Diagnostic Tests.
Diagnostic Tests. Pneumatic otoscopy reveals a reddened, bulging tympanic membrane with
loss of landmarks and poor mobility. Bullae and otorrhea may be seen.
what type of tympanogram will be in P with otitis media
normal-- will be high peak at atmospheric pressure
with effusion--will be mobility of TM but it is dampened, producing a round curve instead of a sharp peak and often more negative middle ear pressure
with eustachian tube dysfucntion( commonly due to sinusitis- negative pressure in the midle ear sapce compared with naso pharynx and middle ear pressures are in the most extreme negative range--- -400 to -200
with perforated TM ear canal and middle ear are at the same pressure so, applying a force to the ear canal produce a flat tracing often with high volume ( higher on y curve)

air pressure on x axis and volume on y axis . healthy TM will be in -200 to +2-- daPa
otitis media less than 3-4 months. next step
audiometry to access the level of hearing loss
if loss -- miryngotomy- to release the fluid and insert tympano stomy tubes

if more 4 month- do miringotomy

if normal hearing test- observation/ AB
when to choose the observation over AB
if minimal pain , no fever or other systemic symptoms
Treatment
Treatment. Treatment consists of oral antibiotics. Amoxicillin is still the drug of choice for
uncomplicated acute otitis media. Otalgia or fever persisting after 72 h of therapy should be
considered a treatment failure, and a change in antibiotics is indicated, usually to high-dose
amoxicillin and clavulanic acid or cephalosporins. Supportive treatment includes antipyretics
and analgesi
dose
when should be better
high dose- 90mg/kg day
in 24-48 hours , if no- change the AB
complication of otitis media
mastoididtis
brain abscess
meningitis facial palsy- because of nerve proximity to middle ear
pain
fever
ear is bulging outward
point tenderness
mastoiditis
cause by str pneum
pseudomona
h infl
60 % in kids < 2 year old
if infection is spread to the underlyng bone-- acute mastoid osteitis( maybe surgery require)
if inf spread to theoverlying periosteum( not bone)- mastoididtis
how to confirm mastoididtis
CT to distinguish ostetis from mastoididtis

if mastoididtis- next step-myringotome and parenteral AB
Eustachian tube dysfunction after viral infection
common in weeks afterafter upper resp infect
exam-- retracted TM
maybe complain of frequent popping pain or pressure

tx - OTC medicine+ pseudo ephedrine and nasal saline sprays
if otitis = inserted tympanostomy tubes and infection- purulent discharge- tx?
topical AB- amoxicillin
bugs involved in chronic supprative otitis
S a
E coli
proteus
S pn
psudomona- rare if no perforation
chronic suppurative otitis tx
topical AB
oral AB
hearing evaluation
surgery intervention if choleosteatoma