Transcript AOM - SBH Peds Res

AOM
Otitis Media
 Otitis Media with effusion (OME)
 Acute Otitis Media (AOM)
 Recurrent AOM
 Chronic Otitis Media/Chronic Otitis Media with effusion
 Chronic Suppurative Otitis Media (CSOM)
Epidemiology
 Seasonal Peak: winter months
 90% of children have at least one symptomatic or
asymptomatic episode by 2yrs of age
 Incidence Peaks: 6-18months of age
Risk Factors

Age <2yrs

Atopy

Bottle propping

Chronic sinusitis

Ciliary dysfunction

Cleft palate and craniofacial anomalies

Child Care attendance

Down Syndrome and other genetic conditions
Pathogenesis
 Impaired eustachian tube function
 Negative pressure increases
 Nasopharyngeal contents are aspirated into middle ear
 Increased vascular permeability: development of MEE
Viruses
 RSV
 Paraflu (types 1,2,3)
 Influenza (type A and B)
 Adenovirus
 Coronavirus
Bacteria
 Streptococcus Pneumoniae
 Nontypeable Hemophilus influenza
 Moraxella catarrhalis
 S. pyogenes (Group A strep)
 Staph Aureus (less common)
PE: OME vs AOM
 Fluid in middle ear space
 AOM: inflammation, specifically otalgia and fever
 OME: TM appears opaque or cloudy
 AOM: red or dark-yellow discoloration of TM or bulging
of TM
Normal TM
OME
AOM
Management
 Observation
 Treatment
Management
 <6months: antibacterial therapy
 6months to 2years with certain diagnosis: antibacterial
therapy
 6months to 2 years with uncertain diagnosis: antibacterial
therapy or observation
 2yrs and up with certain diagnosis: antibacterial therapy or
observation
 2yrs and up with uncertain diagnosis: observation
Antibiotic
 High dose amoxicillin: 80-90mg/kg/day
 Alternative for penicillin allergy
 Augmentin 90mg/kg per day of amox component
 Ceftriaxone
 Clindamycin
Complications
 Mastoiditis
 Acute labyrinthitis
 Petrositis
 Meningitis
 Brain Abscess
 Epidural Abscess
 Otitic hydrocephalus