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