ISS presentation

Acute Otitis Media & Tonsiliopharyngitis

By: Dr. Shay

1. What type of tonsillopharyngitis is seen here?

A. Exudative/ follicular tonsillitis

B. Acute membranous tonsillipharyngitis
C. Tonsillopharyngitis with vesicles or ulcers
D. Tonsillopgaryngitis with edema
Answer: A
2. In acute membranous tonsillopharyngitis, which of these is a complication?

A. Conjunctivitis
B. Neuritis
C. Aseptic meningitis
D. Encephalitis
Answer: B

Complications of membranous tonsillopharyngitis are neuritis and

myocarditis

The others are complications of tonsillopharyngitis with ulcer

Conjunctivitis
Myocarditis
Aseptic meningitis
encephalitis
3. You are assessing a child who has been brought in with a sore throat
and fever. You suspect tonsillitis and know that certain signs and
symptoms are indicative of this condition. Which of the following should
you consider? (Select two)

A. The child has been having dif culty swallowing.

B. The child has been experiencing ear pain.
C. The child has a rash on their arms and legs.
D. The child’s tonsils appear red and swollen.
E. The child has been experiencing frequent nosebleeds
fi
Answer: A & D

The child has been having dif culty swallowing. Dif culty swallowing is a
common symptom of tonsillitis. In amed tonsils can make swallowing
painful and dif cult.

The child’s tonsils also appear red and swollen. Red and swollen tonsils are
characteristic signs of tonsillitis. In ammation of the tonsils is a key
indicator of the condition.

While ear pain can be associated with throat infections, it is not a direct
symptom of tonsillitis. A rash is also not a typical symptom of tonsillitis. It
could indicate other conditions such as an allergic reaction or viral illness.
Nosebleeds could be due to other factors such as dry air or nasal irritation.
fi
fi
fl
fl
fi
4. With when a patient, usually a child, is diagnosed
with strep throat _____ or more times in a year, the
physician may suggest a _______________

A. 7, tonsillectomy
B. 3, salt water gargle
C. 5, antibiotics
D. 2, throat swab for virus isolation
Answer: A

Tonsillitis is considered recurrent when a child has seven or more documented

infections in 1 year, ve per year for 2 years, or three per year for 3 years. For
an infection to be considered clinically signi cant, there must be a sore throat
and at least one of the following clinical features;

-cervical lymphedenopathy (tender lymph nodes or >2cm)

-tonsillar exudate
-positive culture for group A Beta hemolytic streptococcus
-temperature > 38.3% C.
fi
fi
5. The following are complications of this procedure except?

A. Hemorrhage
B. Emphysema
C. Dehydration
D. Anesthetic accident
E. Airway obstruction
Answer: B

Complications
-Haemorrhage
-Airway obstruction from edema of tongue, palate or nasaopharynx
-Dehydration
-Risk of anaesthetic accidents
6. What management step is being
carried out in the picture below?

A. Otis swab
B. Otoscopy
C. Tympanometry
D. Tympanocentesis
Answer: B Diagnosis And
Investigation
•Otoscopy is a clinical procedure used •Ear swab, m/c/s
to examine structures of the ear,
•visualization of the
particularly the external auditory canal,
tympanic membrane, and middle ear.
eardrum with an
•Tympanometry. This test measures otoscope otoscope
the movement of the eardrum. •full blood count
•Tympanocentesis. Rarely, a doctor •blood culture
may use a tiny tube that pierces the •Audiometry
eardrum to drain uid from the middle •Tympanogram
ear — a procedure called •Temporal bone CT and
tympanocentesis MRI
fl
7. About the types of otitis media, which is incorrect;

A. Acute Otitis Media: in ammation of middle ear of <2 weeks.

B. Serous Otitis Media: (SOM): effusion of the middle ear without evidence of accurate
or systemic infection.
C. Chronic Otitis Media (COM): middle ear infection of 2 weeks without episodes of ear
discharge.
D. Adhesive Otitis Media (AOM): eardrum is sucked into the middle ear space and gets
stuck.
fl
Answer: C

- Acute Otitis Media: in ammation of middle ear of

<2 weeks.
- Serous Otitis Media: (SOM): e usion of the middle
ear without evidence of accurate or systemic
infection.
- Chronic Otitis Media (COM): middle ear infection
of 2 weeks with episodes of ear discharge.
- Adhesive Otitis Media (AOM): when the retracted
eardrum is sucked into the middle ear space and
adheres to the ossicles and other bones of the
middle ear.
fl
ff
8. About the examination ndings in AOM…?

A. Fever
B. Ear fullness
C. Ear pain
D. Edema
E. Otorrhea
fi
Answer: D - seen in acute otitis
externa.

Examination Findings
•Fever, tragal tenderness
•Fullness, bulging, cloudiness
and redness of the lymphatic
membrane
•Blisters on the external side of
the lymphatic membrane
9. About the prevention of otitis media…

A. Encourage exclusive breastfeeding

B. Immunize with emphasis on PCV & HiB
vaccines
C. Screening of the child at birth reduces risk
D. Early dx and tx can avert complications
Answer: C

AOM is not a congenital disease. It’s contracted via bacterial or viral

infections hence there’s no guarantee that screening will minimize
risks of infection.

Bacterial
Streptococcus pneumonia, Haemophilus In uenza, Moraxella
catarahalis, Escherchia coli
Viral
Respiratory Syncryrial virus, Rhino virus, Adenovirus virus,
Parain uenza virus, Coronavirus
fl
fl
10. A 3-yo boy is brought in for evaluation of ear pain. The parent reports that
the patient has been holding the right ear in discomfort for the past 24 hours.
They report an ass. cough and nasal congestion. The patient was born full
term and has otherwise been healthy since birth. Temp 39.4°C, BP 107/55
mmHg, pulse 102/min, RR 32/min, and O2 sat 99% on room air. PE
demonstrates an erythematous, bulging tympanic membrane with a purulent
effusion and impaired mobility following insuf ation. There is no otorrhea
present. The patient is started on high-dose amoxicillin and acetaminophen
for analgesia. 48hrs later, the patient returns for reassessment with persistent
ear discomfort. Repeat otoscopic exam shows persistent erythema, bulging,
and purulent effusion of the tympanic membrane. Which of the following is
the best next step in management?

A. Change amoxicillin to amoxicillin-clavulanate

B. Complete the course of amoxicillin
C. Reassess in 48 hours
D. Administer topical corticosteroids
fl
Answer: A

This pediatric patient presents with acute ear pain and ndings
suggestive of acute otitis media. Diagnosis of acute otitis media is
dependent on direct otoscopy of the tympanic membrane, which in
this case, revealed an erythematous, bulging tympanic membrane
with impaired mobility. This patient has evidence of severe otitis
media based on his fever >39 °C, mandating antibiotic therapy. Given
the inadequate clinical response to initial treatment with high-dose
amoxicillin, the best next step in management is to broaden antibiotic
coverage by changing amoxicillin to amoxicillin-clavulanate.
Examination Findings in otitis media Treatment
•Antibiotic according to sensitivity
•Fever, tragal tenderness
test: amoxicillin remains the 1st Line,
•Fullness, bulging, cloudiness and other antibiotics including cotrimox-
redness of the lymphatic membrane azole, Amoxicillin + clavulanic acid
•Blisters on the external side of the •Analgesia and antipyretic for fever
lymphatic membrane and ear pain.
•Aural toileting

fi