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OTITIS MEDIA Definition: Presence of a middle ear infection Acute Otitis Media: occurrence of bacterial infection within the middle ear cavity Otitis Media with Effusion: presence of nonpurulent fluid within the middle ear cavity OM is the second most common clinical problem in childhood after upper respiratory infection
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OTITIS MEDIA
Dr.Isazadehfar
OTITIS MEDIA Definition: Presence of a middle ear infection Acute Otitis Media: occurrence of bacterial
infection within the middle ear cavity Otitis Media with Effusion: presence of
nonpurulent fluid within the middle ear cavity OM is the second most common clinical
problem in childhood after upper respiratory infection
EPIDEMIOLOGY Peak incidence in the first two years of life (esp.
6-12 months) Boys more affected girls 50% of children 1 yr of age will have at least 1
episode. 1/3 of children will have 3 or more infections by
age 3 90% of children will have at least one infection by
age 6 Occurs more frequently in the winter months
MICROBES AT FAULT!!!
Streptococcus pneumonia Homophiles influenza(non-typeable) Moraxella catarrhalis Group A Streptococcus Staph aureus Pseudomonas aeruginosa RSV assoc. with Acute Otitis Media
Classification of Otitis Media
Acute Otitis Media: presents with fever, otalgia, and hearing loss
Otitis Media with Effusion: evidence of middle ear effusion on pneumatic otoscopy
Recurrent Otitis Media: inability to clear middle ear effusions
Chronic Serous Otitis Media: presents as ‘fullness in the ear’, tinnitus, or another acute disease
RISK FACTORS
Upper Respiratory Infections Allergies Craniofacial abnormalities (cleft palate) Down’s Syndrome Passive smoking
PATHOGENESIS
This problem mainly deals with Eustachian tube dysfunction
Otitis Media usually follows an URI in which there is edema of the eustacian tube, leading to blockage. Stasis of these middle ear secretions lead to infection and irritation
Other factors: allergic rhinitis, nasal polyps, adenoidal hypertrophy
SIGNS & SYMPTOMS Neonates/Infants: change in behavior,
irritability, decreased appetite, vomiting
Children(2-4): otalgia, fever, noises in ears, cannot hear properly, changes in personality
Children (>4): complain of ear pain, changes in personality
On Physical exam…
The classic description → erythematic, opaque, bulging tympanic membrane with loss of anatomic landmarks including a dull/absent light reflex
Pneumatic Otoscopy → decreased tympanic membrane mobility
DIAGNOSIS
Pneumatic Otoscopy→ standard tool
Impedance Tympanometry Spectral Gradient Acoustic Reflectometry Diagnostic tympanocentesis & myringotomy:
involves puncturing the tympanic membrane and aspirating middle ear fluid to relieve pressure.(Only used if the primary and secondary line treatment fail)
INDICATIONS FOR TYMPANOCENTESIS
Toxic appearing child Failed treatment regimen with antibiotics Suppurative complications Immunosuppressed pt Newborn infant in which the usual pathogens
may not be the case
DIFFERENTIAL DIAGNOSIS
Otitis externa Bullous myringitis Cerumen impaction Dental abscess Foreign body in ear canal Referred pain (parotid/tooth/lymphadenitis)
Tonsilitis
TREATMENT
Amoxicillin: 20-40 mg/kg/day tid for 10-14 days or,
Augmentin: 45 mg/kg/day po bid for 10-14 days (amoxicillin and clavulanate potassium)
Auralgan: analgesic/adjunct for ear pain 2-4 drops tid (antipyrine, benzocaine, and dehydrated glycerin)
2nd Line Treatment Regimen
Cefzil Pediazole ( erythromycin/sulfisoxazole) Bactrim (trimethoprim/sulfamethoxazole These medications are used as
secondary agents if the primary antibiotic has failed after 10 days and the symptoms persists.
COMPLICATIONS
Hearing loss: conductive, sensoneural, mixed) Acute mastoiditis: before the advent of antibiotics Chronic perforation of the TM Tympanosclerosis Cholesteatoma(keratin cyst) Chronic suppurative OM Cholesterol granuloma: ‘Blue drum syndrome’ Facial nerve paralysis
Complications cont…
Intracranial complications Bacterial meningitis Epidural abscess Subdural empyema Brain abscess Otitic hydrocephalus Lateral sinus thrombosis
What Is Chronic otitis media?
Inflammation of the middle ear that lasts for more than 6 weeks
Usually preceded by Acute otitis media, or viral URTI
Common in the age 3-6
Causes and predisposing factors: Late onset or inappropriate antibiotic treatment of
acute otitis media. URTI, Allergic rhinitis Lowered Resistance in malnutrition and anemia In early onset type: Short period breastfeeding and
long time group child care Eustachian tube deformity, adenoid hypertrophy Septal deviation, cleft palate, sinusitis
Symptoms: Conductive deafness Vertigo Tinnitus Ear discharge
Etiologies Pseudomonas aerugenosa Proteus E.coli H. influenza
1. Serous ( Otitis media with effusion OME )
Stages: 1. URTI or acute otitis media –> Fluid collection in
middle ear and obstruction of Eustachian tube tympanic membrane retraction
2. Fluid become pus and glue like conductive hearing impairment and pain necrosis tympanic membrane perforation
3. Could end up with mastoiditis ( if not stopped ) Enlarged adenoid is most common cause in children
Management of serous Chronic otitis media Systemic decongestants Nasal drops Surgery ( myringotomy ) , if the above 2 failed
Myringotomy is tiny incision done in the ear drum to relief pressure and drain pus
CHOLESTEATOM