second most common disease of childhood after upper respiratory infection most common cause for childhood visits to a physicians office Roughly 16 million office visits annually Infection or inflammation of the middle ear cavity ID: 914662
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Slide1
Otitis Media
Slide2Definition
Otitis media (OM):
second most common disease of childhood (after upper respiratory infection)
most common cause for childhood visits to a physician's office
Roughly 16 million office visits annually
Infection or inflammation of the middle ear cavity
Classified into many variants on the basis of etiology, duration, symptomatology, and physical findings.
Slide3Epidemiology
90% of children have at least one documented middle ear effusion by age of 2 years
OM is frequently recurrent
1/3 of children experience more than 6 episodes of acute OM by the age of 7 years
Slide4Classification
Slide5Signs and Symptoms
Acute Otitis Media (AOM)
cause rapid onset of ≥ 1 of the following symptoms:
Otalgia
Otorrhea
Irritability
Fever
Loss of appetite
Young children may also tug on their ear(s)
Otitis Media with Effusion (OME)
often follows an episode of AOM. Symptoms include :
Hearing loss
Tinnitus
Vertigo
Otalgia
Slide6Acute OM (AOM)
Otoscopic
Appearance:
Purulent effusion behind bulging tympanic membrane (TM)
Severely inflamed osseous canal
Increased vascularity
http://img.medscapestatic.com/pi/meds/ckb/15/44915tn.jpg
R3
Slide7OM with Effusion (OME)
http://www.utmb.edu/pedi_ed/aom-otitis/grading.htm
Otoscopic
Appearance:
Erythema
Effusion (partial or complete)
Opacification
Bulging of TM outward
Slide8Adhesive OM
Otoscopic
Appearance:
Chief sign is
tympanic membrane
immobility
Appearance may
vary from minimal scarring to TM thickening and opacity.
Severe retraction of the TM
http://ts1.mm.bing.net/th?id=OIP.M465c1cff0859f5dc62202b04fae5bfd9o0&pid=15.1
Slide9Chronic Suppurative OM
Otoscopic
Appearance:
Perforated TM with persistent drainage from the middle ear
Granulation tissue in the medial ear cavity
Edematous and pale middle ear mucosa
http://www.assignmentpoint.com/wp-content/uploads/2013/05/chronic-suppurative-otitis-media.jpg
Slide10Diagnosis
Pneumatic otoscopy
is the gold standard examination
Examination should include description of the following four TM characteristics:
Color
–Yellow or blue coloration of the TM is consistent with effusion
Position
– In AOM: the TM is usually bulging whereas in OME, the TM is typically retracted or in the neutral position
Mobility
– decreased TM mobility
Perforation
– Single perforations are most common
Pneumatic Otoscopy Exam: https://emedicine.medscape.com/article/1348950-overview#a7
Slide11Diagnosis
Lab testing
Usually unnecessary
Sepsis
workup is recommended in infants with <12 week with fever and AOM
Appropriate laboratory studies to confirm the etiology for OM when suspecting systemic diseases or congenital syndromes as OM is commonly associated.
Slide12Diagnosis
Imaging
Imaging usually not indicated (Exception include: Suspected intra-temporal or intracranial complications)
Contrast-enhanced CT
Diagnose complications such as mastoiditis, epidural abscess, sigmoid sinus thrombophlebitis, brain abscess, and subdural abscess.
MRI is usually performed if CT is unrevealing
Slide13Treatment
Pain management
with acetaminophen or ibuprofen either in the presence or absence of antibiotic treatments
AAFP Recommendations for prescribing antibiotics include the following:
Antibiotics should be prescribed for
bilateral or unilateral
AOM in children aged at least 6 months with
severe signs
or
symptoms
and for
nonsevere
,
bilateral
AOM in children aged 6 to 23 months
On the basis of joint decision-making with the parents, unilateral,
nonsevere
AOM in children aged 6-23 months or
nonsevere
AOM in older children may be managed either with antibiotics or with close follow-up and withholding antibiotics unless the child worsens or does not improve within 48-72 hours of symptom onset
Amoxicillin
is the antibiotic of choice unless the child received it within 30 days, has concurrent purulent conjunctivitis, or is allergic to penicillin; in these cases, clinicians should prescribe an antibiotic with additional beta-lactamase coverage
https://www.aafp.org/patient-care/clinical-recommendations/all/otitis-media.html