FELYANTO PUSPA HARYANI WIRDA YUNITA

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.

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

Streptococcus pneumoniae
Haemophilus influenzae(non-typeable) Moraxella catarrhalis Group A Streptococcus Staph aureus Pseudomonas aeruginosa RSV assoc. with Acute 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.

Upper Respiratory Infections

Allergies

Craniofacial abnormalities (cleft palate)

Passive smoking

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

Neonates/Infants: change in behavior,

irritability, tugging at ears, decreased appetite, vomiting.

Children(2-4): otalgia, fever, noises in ears,

cannot hear properly, personality changes

Children (>4): complain of ear pain, personality

changes

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

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.

Spectral Gradient Acoustic Reflectometry:

measures the condition of the middle ear by assessing
the response of the TM to a sound stimulus. Equivalent to tympanometry for dx of middle ear effusions

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.

With the increasing incidence of drug resistant strains

of S. pneumoniae, CDC recommends the capacity of

clinicians to be efficient in using 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.

Otitis externa
Bullous myringitis Cerumen impaction Dental abscess Foreign body in ear canal Referred pain (parotid/tooth/lymphadenitis) Tonsilitis

Amoxicillin: 20-40 mg/kg/day for 10-14 days

Hearing loss: conductive, sensorineural, mixed)

Acute mastoiditis: before the advent of antibiotics Chronic perforation of the TM Tympanosclerosis Cholesteatoma Chronic suppurative OM Cholesterol granuloma: Blue drum syndrome Facial nerve paralysis

Intracranial complications
Bacterial meningitis Epidural abscess Subdural empyema Brain abscess Otitic hydrocephalus Lateral sinus thrombosis

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.