Otitis Media
What is ePROM.
a site helps with differentiating be tween AOM and OME
Increase of decreases incident of otitis media 1. breast feeding 2. pacifier after 6 months
1. decrease 2. increase
1. What is otitis media characterized by? 2. What is otitis media 3. What is otitis media caused by (4) a. what symptoms are they associated with (2)
1. fluid in the middle ear, is a group of inflammatory and infective processes 2. Dysfunction of the middle ear and the middle ear mucosa 3. bacterial, viral, fungal. a. allergy, upper resp infec
1. What are some simple solutions that can be use to remove flaky cerumen. 2. Before removal with a curette clinician can also irrigate canal with syringe of low pressure stream (water pik). T or F
1. hydrogen peroxide, sodium docusate, mineral oil 2. True
1. What does acute discharge without acute otitis externa indicate. 2. Discharge should be culture to determine organism to guide __________selection.
1. perforation of TM 2. treatment
1. Chronic effusion AKA a. it can occur for several months, is it with or w/o symptoms or either
1. serous otitis media or glue ear a. can occur with or w/o symptoms
What does absent or decreased mobility indicate.....AOM or OME, chronic serous otitis, or MEE Is MEE also one of the necessary criteria for AOM
MEE Yes
Hearing loss or impairment can occur how long after otitis media after infection stage
weeks to months
1. What is otitis media effusion/ a. does it include inflammation b. can it proceed or follow AOM c. is it an infection ..... does it have purulent dx
1. a. w/o inflammation b. yes c. no. and no
Tx length 1. mild to mod otitis media 6 yrs and > 2. sever otitis media younger that 2 yrs 3. mild to mod otitis media children 2-5 yrs
1. 5-7 days 2. 10 days 3. 7 days
Differing visualization of tympanic membrane is important to determing diagnoses. 1. TM changes are important in determining what 2 types of otitis media....which will have bulging, give specifics and which will have retraction with decrease to no move ment
1. AOM and OME...AOM will have bulging with obscure landmarks. OME will have TM retraction and no symptoms
1. The otoscope examination will help to distinguish between what 2 otitis media infec. 2. Presence of rapid onset of otalgia worse in supine or prone position is common c/o pt with AOM or OME 3. What is the most common complaint for pt with OME. Will they be symptomatic or asymptomatic.
1. AOM or OME 2. AOM 3. Conductive hearing loss. mostly asymptomatic with mild pain, ear popping, vertigo, ear fullness, ear stiffness
1. What is middle ear effusion? a. what is it associated. and how long after the precipitating infection can MEE occur 2. Decreased mobility with pneumatic otoscope indicates what in AOM
1. An accumulation of serous fluid in the middle ear a. AOM, can persist for several weeks or months after episode of AOM 2. It indicates MEE
What diag is _________ indicated. 1. chronic otitis media with suspected intratemporal or intracranial complications 2. reccurent otitis media and allergies 3. immunocompromised 4. recurrent otitis infection to determine organism and or for antibiotic sensitivity, or if 3 days tx with a second agent was not effective. does this deserve a special referral
1. CT 2. Allergy testing 3. CBC with differential 4. Tempanocentesis. yes
1. Antecendent events/illnesses and life choices that may preceed otitis media (4) a. why are smokers prone to otitis media (2) b. can middle ear secretion accumulate in the eustacian tube and cause ear infection....
1. bact or viral infection, allergy, upper resp infection (sometimes due to smoking) a. because smoking may decrease muscilary funct of eustacian and cause resp infections b. yes. this is how ear infection occur as it relates to eustacian tubes
Is antibiotic recommended 1. Non severe bilateral AOM with temp < 39 degrees celcius less than 48 hrs in children less than 24 months with mild otalgia 2. Severe (bilateral or unilateral) AOM in children 6 months and older with moderate to severe otalgia or fever 39 C or > 3. AOM with otorrhea 6 months or older 4. Nonsevere AOM(bilat or unilat) in children 24 mn or older with mild otalgia for less than 24 hrs and fever below 39 C 5. Nonsevere AOM unilateral in children 6-23 months with mild otalgia and fever below 39 C
1. antibiotic tx 2. antibiotic tx 3. antibiotic tx 4. antibiotic tx or observation 5. antibiotic tx or observation
1. What causes otitis media the most, viral or bact 2. what bact organisms are responsible for otitis media...name as many as you can (3)
1. bact 2. staph, strep, haemophilus influenza
Peak incidence of otitis media occurs in what age range in months
6-15 months
What is a pneumatic otoscope and what is it used to determine.
A pneumatic otoscope is an otoscope with a bulb that blows air/pressure in the ear canal and it is used to determine mobility of TM.
Otorrhea without external otitis media is diagnosed as
AOM
How is pain treated Is antihistimine, decong, and steriods benifical for tx of AOM or OME When should pt return a. if symptoms worsen b. if not better within 72 hours
Acetaminophen or ibuprofen NO a. immediately b. within 72 hrs
What sinuses are often tender and non transluminating (2) What 2 lympnodes may be enlarged and warm
Frontal and maxillary Post auricular or cervical lymph nodes
Does diagnoses of AOM requires new or old onset or of otorrhea. Is pain required. What can be other requirements of AOM (3) Might fluid or bubbles be present in AOM...what does this indicate
New. Yes new onset of pain is required Moderate to severe BULGING (very important) without other signs or mild bulging and recent (less than 48 hrs) pain or intense erythema of TM. Presence of MEE (mild ear effusion. Yes. Indicates effusion
Which has fluid present without signs of acute infection such as erythema and exudates and looks injected. AOM or OME or chronic serous otitis Which is normally amber or blueish color with diffuse light reflex and is defined as occuring 3 or more in 6 month or 4 within or more within a year. AOM or OME or chronic serous otitis Retraction is a common finding of AOM or OME or chronic serous otitis MEE is most common in AOM when what is present Chronic serous otitis should be referred to.....
OME chronic serous otitis OME otorrhea ENT
what vaccines may have a protective effect on otitis media (2)
PVC and influenza
Is AOM accompanied by a cold or influenza.
Usually but not always
At about what age does otitis incident decrease and why Why does otitis media normally occur in adults
about age 7 because the eustacian tubes mature smoking
What antibiotic is 1st line tx for otitis med. what are 2 situation should be considered before prescribing this antibiotic (3)
amoxicillin allergy to pcn, or received in past 30 days, or prurelent conjuctivitis
If child has had amoxicillin within 30 day, or has prurelent conjunctivitis what antibiotic is preferred if not allergic to pcn
amoxicillin with beta lactamase
Acute otitis media is normally what type of infection of the middle ear fluid (2)?
bact or viral
What's a common sequels of AOM and OME
eardrum perforation
Name some associated symptoms that require further investigation
headache, eye drainage, nasal congestion, sore throat and mouth pain.
Bullae between TM layer indicate what type of organism
mycoplasma pneumonia
Cerumen removal with a ear curette may be necessary to view the TM. If this does not work irrigations can be done only if there is not a ______________ in the TM.
perforation
Under 6 months with possible sepsis. children with conditions such as tympanostomy tube, auditory or craniofacial abnormalities, or cochlear implant should be. Child who may appear more lethargic than signs and symptoms suggest should be _____________. ENT referral for what type of otitis Speech and audiology referral indicated for younger children with OME that fails to resolve....this is for possible need of :::::::::is adenoidectomy required
referred to specialist chronic otitis media ventilating tubes. can have referral with or without adenoidectomy
Otitis media that occurs in adults is normally due to.....
smoking or 2nd hand smoke