Presentation on theme: "By: Anitha Jacob PA-S November 8, 2000"— Presentation transcript:
1 By: Anitha Jacob PA-S November 8, 2000 OTITIS MEDIABy: Anitha Jacob PA-SNovember 8, 2000
2 OTITIS MEDIA 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 cavityOM is the second most common clinical problem in childhood after upper respiratory infection.
3 EPIDEMIOLOGYPeak incidence in the first two years of life (esp months)Boys more affected girls50% of children 1 yr of age will have at least 1 episode.1/3 of children will have 3 or more infections by age 390% of children will have at least one infection by age 6.Occurs more frequently in the winter months
4 MICROBES AT FAULT!!! Streptococcus pneumoniae Haemophilus influenzae(non-typeable)Moraxella catarrhalisGroup A StreptococcusStaph aureusPseudomonas aeruginosaRSV assoc. with Acute Otitis Media
5 Classification of Otitis Media Acute Otitis Media: presents with fever, otalgia, and hearing lossOtitis Media with Effusion: evidence of middle ear effusion on pneumatic otoscopyRecurrent Otitis Media: inability to clear middle ear effusionsChronic Serous Otitis Media: presents as ‘fullness in the ear’, tinnitus, or another acute disease.
7 PATHOGENESISThis 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 irritationOther factors: allergic rhinitis, nasal polyps, adenoidal hypertrophy
8 SIGNS & SYMPTOMSNeonates/Infants: change in behavior, irritability, tugging at ears, decreased appetite, vomiting.Children(2-4): otalgia, fever, noises in ears, cannot hear properly, changes in personalityChildren (>4): complain of ear pain, changes I personality
9 On Physical exam…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
10 DIAGNOSIS 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
11 Diagnosis cont.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.
12 INDICATIONS FOR TYMPANOCENTESIS Toxic appearing childFailed treatment regimen with antibioticsSuppurative complicationsImmunosuppressed pt.Newborn infant in which the usual pathogens may not be the case.
13 DIFFERENTIAL DIAGNOSIS Otitis externaBullous myringitisCerumen impactionDental abscessForeign body in ear canalReferred pain (parotid/tooth/lymphadenitis)Tonsilitis
14 TREATMENT Amoxicillin: 20-40 mg/kg/day tid for 10-14 days or, Augmentin: 45 mg/kg/day po bid for daysAuralgan: analgesic/adjunct for ear pain 2-4 drops tid
15 2nd Line Treatment Regimen CefzilPediazole ( erythromycin/sulfisoxazole)Bactrim (trimethoprim/sulfamethoxazoleThese medications are used as secondary agents if the primary antibiotic has failed after 10 days and the symptoms persists.
16 COMPLICATIONS Hearing loss: conductive, sensoneural, mixed) Acute mastoiditis: before the advent of antibioticsChronic perforation of the TMTympanosclerosisCholesteatomaChronic suppurative OMCholesterol granuloma: ‘Blue drum syndrome’Facial nerve paralysis
18 REFERENCESDornbrand, Laurie. Manual of Clinical Problems in Adult Ambulatory Care. 3rd ed.,Hoberman, A., Paradise J. Acute Otitis Media: Diagnosis and Management in the Year Pediatric Annals :Nelson. Textbook of Pediatrics Pocket CompanionWetmore, R. Complications of Otitis Media. Pediatric Annals :