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OTITIS MEDIA
Definition: Presence of a middle ear infection Acute Otitis Media: occurrence of bacterial
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 pneumoniae Haemophilus influenzae(non-typeable) Moraxella catarrhalis Group A Streptococcus Staph aureus Pseudomonas aeruginosa RSV assoc. with Acute Otitis Media
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) Downs Syndrome Passive smoking
PATHOGENESIS
This problem mainly deals with eustacian 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
On Physical exam
The classic description for Otitis Media is an 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 for diagnosis Impedance Tympanometry: useful for MEE.
Measures the resonance of the ear canal for a fixed sound as the air pressure is varied.
Diagnosis cont.
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
Augmentin: 45 mg/kg/day po bid for 10-14 days Auralgan: analgesic/adjunct for ear pain 2-4 drops
tid
nd 2
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
Complications cont
Intracranial complications Bacterial meningitis Epidural abscess Subdural empyema Brain abscess Otitic hydrocephalus Lateral sinus thrombosis
REFERENCES
Dornbrand, Laurie. Manual of Clinical Problems in Adult Ambulatory Care. 3rd ed., 1997. 59-61. Hoberman, A., Paradise J. Acute Otitis Media: Diagnosis and Management in the Year 2000. Pediatric Annals 2000. 29:10 609-619. Nelson. Textbook of Pediatrics Pocket Companion Wetmore, R. Complications of Otitis Media. Pediatric Annals. 2000. 29:10. 637-645.