Podcast
Questions and Answers
What condition might multiple perforations and otorrhea, with no pathogens on culture, suggest?
What condition might multiple perforations and otorrhea, with no pathogens on culture, suggest?
- Cholesteatoma
- Otitis externa
- Tuberculosis (correct)
- Acute sinusitis
Which of the following treatments has shown no obvious benefit for acute otitis media (AOM) and otitis media with effusion (OME)?
Which of the following treatments has shown no obvious benefit for acute otitis media (AOM) and otitis media with effusion (OME)?
- Antihistamines (correct)
- Antibiotics
- NSAIDs (correct)
- Decongestants (correct)
What is a common symptom of otitis media in elderly individuals?
What is a common symptom of otitis media in elderly individuals?
- Facial swelling
- Classical signs of inflammation
- Severe respiratory distress
- Otalgia with hearing loss (correct)
What complication can arise from an otitis media infection if it spreads to adjacent structures?
What complication can arise from an otitis media infection if it spreads to adjacent structures?
Which of the following is NOT a treatment option of antimicrobials for otitis media?
Which of the following is NOT a treatment option of antimicrobials for otitis media?
What is a potential intracranial complication of untreated otitis media?
What is a potential intracranial complication of untreated otitis media?
Which of the following does not commonly occur in elderly patients with otitis media?
Which of the following does not commonly occur in elderly patients with otitis media?
Which of the following viruses is listed as part of the differential diagnosis for otitis media?
Which of the following viruses is listed as part of the differential diagnosis for otitis media?
What is the appearance of a normal tympanic membrane (TM)?
What is the appearance of a normal tympanic membrane (TM)?
What does a bulging TM typically indicate?
What does a bulging TM typically indicate?
Which mobility characteristic suggests the presence of middle ear fluid?
Which mobility characteristic suggests the presence of middle ear fluid?
In which condition is the TM most likely to be in a retracted position?
In which condition is the TM most likely to be in a retracted position?
What type of TM perforation is most commonly associated with cholesteatoma?
What type of TM perforation is most commonly associated with cholesteatoma?
Which symptom is NOT typically associated with a middle ear infection?
Which symptom is NOT typically associated with a middle ear infection?
What indicates a recent trauma involving the TM?
What indicates a recent trauma involving the TM?
What does the presence of pus or other fluid through a TM perforation indicate?
What does the presence of pus or other fluid through a TM perforation indicate?
Which type of otitis media is characterized by a rapid onset of symptoms like ear pain and fever?
Which type of otitis media is characterized by a rapid onset of symptoms like ear pain and fever?
What is a key pathological factor contributing to middle ear disease?
What is a key pathological factor contributing to middle ear disease?
Which symptom is NOT typically associated with acute otitis media?
Which symptom is NOT typically associated with acute otitis media?
What does OM with effusion typically follow?
What does OM with effusion typically follow?
Chronic suppurative otitis media is characterized by which of the following?
Chronic suppurative otitis media is characterized by which of the following?
Which condition occurs when a thin retracted eardrum is sucked into the middle ear space?
Which condition occurs when a thin retracted eardrum is sucked into the middle ear space?
What is NOT a typical clinical presentation of otitis media?
What is NOT a typical clinical presentation of otitis media?
Which symptom is often observed in patients with otitis media?
Which symptom is often observed in patients with otitis media?
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Study Notes
Otitis Media
- Otitis media (OM) refers to inflammation of the middle ear.
- It's a common condition, especially in children.
Types of Otitis Media
- Acute Otitis Media (AOM): rapid onset of inflammation with pain, ear discharge, headache, fever, irritability, loss of appetite, vomiting, and diarrhea.
- Otitis Media with Effusion (OME): occurs after an episode of AOM. The middle ear is filled with fluid.
- Chronic Suppurative Otitis Media (CSOM): Persistent ear infection that causes tearing or perforation of the eardrum.
- Adhesive Otitis Media: A thinned and retracted eardrum becomes stuck to the middle ear space.
Pathophysiology of Otitis Media
- Eustachian tube dysfunction (ETD) is a key factor in middle ear disease.
- ETD can interfere with the mucociliary system of the middle ear, facilitating the spread of infection from the nasopharynx to the middle ear.
- Esophageal contents regurgitated into the nasopharynx can cause irritation and inflammation of the middle ear via the Eustachian tube.
Symptoms of Otitis Media
- Ear pain
- Ear discharge
- Headache
- Fever
- Irritability
- Lethargy
- Loss of appetite
- Nausea/Vomiting
- Diarrhea
- Symptoms of an upper respiratory infection
Physical Examination of Otitis Media
- The standard examination technique is pneumatic otoscopy.
- It can be 90% sensitive and 80% specific for diagnosing AOM.
- Color: A normal eardrum is translucent, pale gray. Opaque yellow or blue indicates middle ear effusion. Dark red suggests recent trauma or blood. Dark pink or lighter red indicates AOM or hyperemia from crying, coughing, or nose blowing.
- Position: In acute otitis media (AOM), the eardrum is usually bulging. In OME, it's typically retracted or neutral.
- Mobility: A slightly mobile eardrum with both positive and negative pressure indicates middle ear fluid. Lack of movement suggests perforation or a tight eardrum.
- Perforation: Single perforations are common. Multiple perforations should be noted and investigated. Perforations in the posterosuperior quadrant are often associated with cholesteatoma. Pus or fluid may drain through a perforation.
Differential Diagnosis
- Acute sinusitis
- Bacteremia
- Cholesteatoma
- Colic
- Diarrhea
- Fever without a focus
- Hearing impairment
- Nasopharyngeal cancer
- Otitis externa
- Parainfluenza viruses
Treatment
- Antimicrobials: Amoxicillin, Augmentin, Ceclor, Cefprozil, Ceftin, Suprax, Rocephin, Zithromax, Bactrim, Erythromycin.
- Studies have shown no significant benefit from NSAIDs, decongestants, or antihistamines.
Otitis Media in Elderly
- Elderly patients do not always present with the classic symptoms seen in children.
- They may experience ear pain with or without hearing loss or signs of inflammation.
- Infections can spread to adjacent structures, leading to mastoiditis, petrositis, labyrinthitis, facial nerve palsy, or intracranial complications like meningitis, abscesses, encephalitis, and venous sinus thrombosis.
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