Otitis Media Overview and Classification

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Questions and Answers

What are the primary bacterial pathogens responsible for acute otitis media?

The primary bacterial pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

How can enlarged adenoids contribute to acute otitis media?

Enlarged adenoids can cause physical obstruction of the eustachian tube and serve as a reservoir for pathogenic bacteria.

List at least two signs and symptoms of acute otitis media in infants.

Signs in infants include irritability and tugging at the ears.

What ear-related sensation might a patient with acute otitis media experience?

A patient may experience a blocked ear sensation and rapidly increasing pain. Signup and view all the answers

What physical finding might be observed on the tympanic membrane during an examination of a patient with acute otitis media?

The tympanic membrane may appear dull, hyperemic, and display visible radial vessels. Signup and view all the answers

What occurs to the tympanic membrane as suppuration progresses in acute otitis media?

As suppuration progresses, the tympanic membrane may rupture, allowing mucopus to drain. Signup and view all the answers

What is the definition of otitis media?

Otitis media is the inflammation of the mucosa in the middle-ear cleft, including the eustachian tube, tympanic cavity, and mastoid air cells. Signup and view all the answers

What is the typical outcome of acute suppurative otitis media with appropriate antibiotic treatment?

The condition resolves completely in 90-95% of cases with antibiotic treatment. Signup and view all the answers

Distinguish between acute otitis media and chronic otitis media based on their duration.

Acute otitis media lasts less than 3 weeks, while chronic otitis media persists for 3 months or longer. Signup and view all the answers

What behavioral changes might indicate acute otitis media in children older than four years?

Children may complain of ear pain and exhibit changes in personality. Signup and view all the answers

What are the normal functions of the eustachian tube in the context of otitis media?

The eustachian tube maintains middle ear pressure, prevents reflux from the nasopharynx, and clears secretions from the middle ear. Signup and view all the answers

How is recurrent otitis media defined?

Recurrent otitis media is defined as having 3 attacks in 6 months or 4 attacks within one year. Signup and view all the answers

What distinguishes suppurative from nonsuppurative acute otitis media?

Suppurative acute otitis media is characterized by pus formation, while nonsuppurative does not involve pus. Signup and view all the answers

What is the primary symptom of otitis media with effusion in children?

Decreased hearing. Signup and view all the answers

How can otoscopy findings indicate otitis media with effusion?

A dull gray- or yellow colored tympanic membrane with reduced mobility is observed. Signup and view all the answers

What does a Type B tympanometry graph indicate?

It indicates otitis media with effusion (OME). Signup and view all the answers

Why might some patients with otitis media with effusion require no treatment?

Many patients experience spontaneous resolution, especially if hearing impairment is mild. Signup and view all the answers

What non-surgical treatments are recommended for otitis media with effusion?

Medical treatments include antibiotics, steroids, decongestants, and antihistamines. Signup and view all the answers

What is the purpose of tympanostomy tubes in otitis media with effusion treatment?

They help drain fluid and equalize pressure in the middle ear. Signup and view all the answers

Name a possible complication of untreated otitis media with effusion.

Delayed speech development in younger children. Signup and view all the answers

What might indicate the beginning of middle ear problems during audiometry testing?

Mobility to the negative side on the tympanometry graph (Type C). Signup and view all the answers

What clinical methods are used for diagnosing acute suppurative otitis media (AOM)?

Diagnosis of AOM is made clinically through patient history, otoscope examination, and pneumatoscope tests. Signup and view all the answers

What are the treatment goals for acute suppurative otitis media?

The treatment goals include decreasing the duration of fever and pain, expediting the return to normal activity, and limiting potential complications. Signup and view all the answers

Under what conditions is watchful waiting recommended for AOM in children?

Watchful waiting is recommended for healthy children aged 2 years or older with nonsevere illness and mild symptoms. Signup and view all the answers

What is the usual antibiotic treatment for children diagnosed with AOM?

Common antibiotic treatments include Augmentin at 90 mg/kg/day or Ceftin at 30 mg/kg/day, both divided into two doses. Signup and view all the answers

What should be considered for children with penicillin allergies when treating AOM?

For penicillin allergic children, trimethoprim/sulfamethoxazole or erythromycin/sulfisoxazole are the initial antibiotic choices. Signup and view all the answers

What adjunctive therapies should be included in the treatment of AOM?

Adjunctive therapies should include analgesics and antipyretics to alleviate pain and fever. Signup and view all the answers

In what situations is myringotomy indicated for patients with AOM?

Myringotomy is indicated for patients who fail medical therapy or develop complications from AOM. Signup and view all the answers

What are the indications for tympanocentesis in treating AOM?

Indications for tympanocentesis include a toxic appearing child, failed antibiotic treatment, suppurative complications, and immunocompromised patients. Signup and view all the answers

What is otitis media with effusion and how long must the effusion persist to be classified as such?

Otitis media with effusion is defined as the persistence of a serous or mucoid middle ear effusion for 3 months or more. Signup and view all the answers

What percentage of children experience otitis media with effusion for over 3 months?

10% of children experience otitis media with effusion for over 3 months. Signup and view all the answers

Identify two common risk factors associated with otitis media with effusion.

The risk factors for otitis media with effusion include recurrent acute otitis media and factors causing overproduction or impaired clearance of mucus. Signup and view all the answers

What is the most common cause of hearing loss in children in the developed world?

Otitis media with effusion is the most common cause of hearing loss in children in the developed world. Signup and view all the answers

What is tympanosclerosis and how can it affect hearing?

Tympanosclerosis refers to the thickening or scarring of the tympanic membrane and can lead to conductive hearing loss if it affects the middle ear and ossicles. Signup and view all the answers

Describe the role of mucociliary transport in maintaining normal middle ear health.

Mucociliary transport removes mucus secreted by the middle ear mucosa into the nasopharynx, helping to clear potential infections. Signup and view all the answers

What types of infections can lead to increased production and viscosity of secretions from the middle ear mucosa?

Both viral and bacterial infections can lead to increased production and viscosity of secretions in the middle ear. Signup and view all the answers

How can acute suppurative otitis media lead to chronic conditions in children?

Acute suppurative otitis media can result in adhesions and eroded structures in the middle ear, potentially leading to long-term complications like hearing loss. Signup and view all the answers

Study Notes

Otitis Media

Inflammation of the mucosa of the middle ear cleft, including the eustachian tube, tympanic cavity, and mastoid air cells.

Classification of Otitis Media

Acute Otitis Media:
- Rapid onset of signs and symptoms
- Course less than 3 weeks
Subacute Otitis Media:
- Course between 3 weeks and 3 months
Chronic Otitis Media:
- Course 3 months or longer
Recurrent Otitis Media:
- At least 3 attacks within 6 months or 4 attacks within a year

Acute Suppurative Otitis Media (ASOM)

Predominantly a bacterial infection
Most common pathogens:
- Streptococcus pneumoniae (up to 40%)
- Haemophilus influenzae (25-30%)
- Moraxella catarrhalis (10-20%)
Adenoids can influence ASOM by:
- Physically obstructing the eustachian tube when enlarged
- Serving as a reservoir of pathogenic bacteria

ASOM: Signs & Symptoms

Neonates/Infants:
- Change in behavior
- Irritability
- Tugging at ears
- Decreased appetite
- Vomiting
Children (2-4 years):
- Otalgia (ear pain)
- Fever
- Noises in ears
- Difficulty hearing
- Changes in personality
Children (>4 years):
- Complain of ear pain
- Changes in personality
Common symptoms:
- Preceding URTI
- Pain, which may increase in intensity
- Blocked ear sensation
- Fever
- Deafness (progresses as suppuration occurs)
- Mucopurulent otorrhoea (drainage from the ear) after tympanic membrane rupture

ASOM: Examination

Tympanic membrane:
- Dull on examination
- Hyperaemia (redness)
- Visible blood vessels
- Middle ear effusion
- Red and angry appearance
- Pressure necrosis causes the membrane to rupture
- Mucopus drains into the external ear canal

ASOM: Diagnosis

Clinical diagnosis based on history, otoscopic examination, and pneumatoscopy (air insufflation)
Pneumatoscopy: No mobility of the tympanic membrane indicates middle ear effusion

ASOM: Treatment

Goals:
- Reduce fever and pain
- Expedite return to normal activity
- Minimize the potential for suppurative complications

ASOM: Nonsurgical Measures

Watchful waiting:
- Consider for healthy children 2 years or older with mild symptoms (mild otalgia and fever < 39°C)
- Symptoms often improve within 1-3 days
- Not recommended for children under 2 years old
Antibiotic therapy:
- First-line options:
  - Augmentin (amoxicillin/clavulanate) 90 mg/kg/day divided BID for 10-14 days
  - Ceftin (cefuroxime axetil) 30 mg/kg/day divided BID
  - Rocephin (ceftriaxone) 50 mg/kg/doseIM/IV q day for 3 days
- For penicillin allergies:
  - Trimethoprim/sulfamethoxazole
  - Erythromycin/sulfisoxazole
Adjunctive therapy:
- Analgesics (pain relievers)
- Antipyretics (fever reducers)

### ASOM: Surgical Measures

Myringotomy:
- Indicated for patients who fail to respond to medical therapy or develop complications
- Surgical incision of the tympanic membrane to drain pus from the middle ear space
- Healing is quicker than a spontaneous rupture
Tympanocentesis:
- Indicated for:
  - Toxic appearing child
  - Failed antibiotic treatment
  - Suppurative complications
  - Immunosuppressed patient
  - Newborn infants

ASOM: Sequelae (Complications)

Non-suppurative middle ear effusion:
- Persists for over 30 days in 40% of children and over 3 months in 10%.
High-tone sensorineural hearing loss:
- Potentially caused by bacterial toxins migrating across the round window.
Tympanic membrane perforation:
- Can occur due to pressure necrosis.
Adhesions:
- Between the tympanic membrane, ossicles, and the medial wall of the middle ear.
Tympanosclerosis:
- Can spread from the tympanic membrane to the ossicular chain.
- Can fix the ossicular chain.
Erosion of the ossicular chain:
- Especially the long process of the incus, particularly after recurrent ASOM.

Otitis Media with Effusion (OME)

Also known as chronic secretory otitis media, chronic serous otitis media, or "glue ear."
Persistence of a serous or mucoid middle ear effusion for 3 months or more.
Nonsterile, non-suppurative fluid with bacteria but no pus, fever, or pain.
Results in decreased hearing.

OME: Prevalence

Most common cause of hearing loss in children in developed countries.
Incidence peaks at 2 and 5 years of age.

OME: Risk Factors

Similar to those for ASOM.
Middle ear effusion often occurs after an episode of AOM.
Children with OME have a higher risk of recurrent AOM.

OME: Pathogenesis

Normal middle ear mucosa constantly secretes mucus cleared via the eustachian tube.
Factors affecting mucus overproduction, impaired clearance, or both lead to OME.
Viral and bacterial infections can increase mucus production and viscosity.
Other contributing factors:
- Eustachian tube dysfunction
- Barotrauma (e.g., scuba diving)
- Exposure to smoking

OME: Symptoms & Signs

Often asymptomatic.
Decreased hearing.
Reduced performance in school.
Speech delay in younger children.
Blocked ear sensation.
Rarely: earache, tinnitus, or balance disorder.

OME: Otoscopic Examination

Typically reveals a dull gray or yellow tympanic membrane with reduced mobility on pneumatic otoscopy.
Translucent membrane may show an air-fluid level or air bubbles within the effusion.

OME: Special Tests

Tympanometry:
- Type A: normal pressure and mobility, indicating normal ear function.
- Type B: flat graph, indicating OME.
- Type C: reduced mobility to the negative side, indicating negative middle ear pressure and often an early sign of middle ear problems.
Audiometry:
- Detects conductive hearing loss.

OME: Treatment

Observation:
- Many patients require no treatment, especially if hearing impairment is mild.
- Spontaneous resolution occurs in a significant number of cases.
- Watchful waiting for 3 months from onset (if known) or diagnosis (if unknown) is recommended before considering intervention.

OME: Nonsurgical Measures

Medical treatments:
- Antiobiotics (to reduce inflammation around the eustachian tube)
- Steroids (to enhance drainage).
Other options:
- Decongestants
- Antihistamines

OME: Surgical Measures

Tympanostomy tubes:
- Surgical placement of tubes in the tympanic membrane to ventilate the middle ear.
- Replace the function of the eustachian tube.
Adenoidectomy:
- Surgical removal of the adenoids if they are enlarged and obstructing the eustachian tube.
Myringotomy and aspiration of middle ear effusion:
- Short-lived benefit and not recommended.

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Description

This quiz covers the important aspects of Otitis Media, including its classification into acute, subacute, chronic, and recurrent types. You'll also learn about Acute Suppurative Otitis Media, its common pathogens, and signs and symptoms, particularly in neonates and infants. Test your knowledge on this common ear condition.