Otitis Media

clinical diagnosis of acute otitis media:

1. bulging of TM OR 2. other signs of acute infection (eryhema, pain, fever) AND a middle ear effusion

children <2 years are treated with abx for AOM for ____________

10 days

T or F? acute otitis media can be associated with systemic symptoms like high fever, anorexia, vomiting, and diarrhea

T

T or F? obsertvation can be used as initial treatment of AOM instead of abx in some situations

T

recurrent AOM must be established with symptoms of ___________________ or other signs of __________________

bulging of TM, inflammation

the angle of the eustachian tube is more ACUTE in _______

children

2 situations where topical analgesics cannot be used for acute otitis media

children <2 TM perforation

this group of children needs to follow-up for AOM in 8-12 weeks to ensure resolution of effusion

children <2 or >/= 2 with language or learning problems

this group of children can wait until next health maintenance to follow-up for AOM

children >/= 2 without hearing or learning problems

should be added to amoxicillin for treatment of AOM if considered risk for PCN-resistant strains

clavulanate (augmentin)

recurrent AOM =

development of signs and symptoms of AOM within 30 days after completion of successful treatment

peak incidence of otitis media occurs in _________________

first 2 years of life

surgical treatment of recurrent AOM that is reserved for severely affected children with symptoms of nasal obstruction or recurrent AOM

adenoidectomy

the ______ can cause physical obstruction of the eustachian tubes if they become enlarged, they can also harbor bacteria inside them

adenoids

3 purposes of the eustachian tube

-maintains pressure -prevents reflux of contents of the nasopharynx into middle ear -clears secretions from middle ear

in general, if it lasts longer than ________ it is considered chronic otitis media

3 months

children >2 are treated with abx for AOM for ______________

5-7 days

prophylactic abx therapy for AOM should be limited to a duration of _______________ (usually in high risk fall-winter-spring months)

6 months

children aged ______________, that are healthy and have unilateral non-severe AOM, treatment of observation vs abx is a clinical decision

6 months-2 years

all children __________ old should be treated with abx immediately for AOM

<6 months

who should we consider for tympanostomy tube insertion?

>/= 3 episodes of AOM in a 6 month period OR >/= 4 episodes in a 12 month period *must have complete resolution of signs/symptoms between episodes*

T or F? decongestiants/antihistamines may be useful for treatment of acute otitis media

F

T or F? ear tubes are used to drain fluid

F

T or F? persistent middle ear effusion after the resolution of acute symptoms indicates treatment failure and indicates additional abx therapy

F

treatment of recurrent AOM more than 15 days of completion of abx

amoxacillin-clavulante

initial treatment of failure to high-dose amoxicillin:

amoxicillin-clavulanate

inflammation of the eustachian tube mucosa or extrinsic compression by tumor or large adenoids

anatomic obstruction

5 reasons a child >/= 2 should be immediately with abx for AOM

appear toxic have persistent otalgia >48 hrs have temp > 102.2 in past 48 hrs bilateral AOM or otorrhea uncertain access to follow-uo

is acute otitis media predominantly a bacterial or viral infection?

bacterial

2 abx NOT recommended for AOM that fail to response to high-dose amoxicillin

bactrim, macrolides

treatment of recurrent AOM within 15 days of completion of abx

ceftriaxone or levofloxacin

treatment of AOM if non-type 1 PCN allergic

cephalosporin

2 other abx that may be used for resistant AOM

cephalosporins, levofloxacin

5 reasons someone is considered at high risk for PCN resistant AOM and should be treated with clavulanate + amoxicillin (augmentin)

day care geographic high incidence previous abx treatment within 30 days purulent conjunctivitis history of AOM unresponsive to amoxicillin

4 environmental RFs for otitis media

day care tobacco smoke seasonal variations bottle feeding

__________________provides favorable medium for proliferation of bacterial pathogens (usually from the nasopharynx)

effusion of fluid

failure of normal muscular mechanism of eustachian tube opening or insufficient stiffness of cartilaginous portion of the eustachian tube (more common in infants and children)

functional obstruction

6 RFs for otitis media specific to the host

genetics FH immunodeficient birth defects down syndrome cleft palate

initial abx used to treat AOM

high dose amoxicillin

in acute otitis media, the TM is often _______________to pneumatic otoscopy

immobile

what is defined as treatment therapy FAILURE in treatment of AOM?

lack of improvement by 48-72 hrs after abx therapy started

treatment of AOM if TYPE 1 (severe) PCN allergic

marcolide or clindamycin

surgical option that decreases morbiditiy associated with AOM

myringotomy with tympanostomy tube

in otitis media, eustachian tube function can be disrupted leading to _____________________developing within the middle ear causing transudation of serous fluid

negative pressure

if ears drain after PE tube insertion = ________________

otitis media

refers to an inflammatory process within the middle ear

otitis media

6 ways to prevent AOM

parental education breast feeding ID and treatment of underlying predisposing conditions vaccination abx prophylaxis surgery

an abnormally __________ or _______________eustachian tube may lead to more otitis media infections, more common in down syndrome

patent, short

2 vaccines that may decrease overall rate of AOM

pneumococcal infleunza

the main purpose of PE ear tubes

pressure equalization

small tubes placed in TM to vent the middle ear and prevent negative pressure build up

pressure equalization tube

3 most common pathogens to cause acute otitis media

s. pneumo h. infleunzae moraxella

treatment of acute otitis media

systemic analgesics topical analgesics abx

not indicated unless severe obstruction symptoms or recurrent tonsil infections also evident

tonsillectomy

otitis media is typically preceded by a ________________

viral URI

3 things that impact mucociliary clearance of Eustachian tube

viral infection bacterial toxins inherited abnormalities of ciliary structure