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Acute

Acute. otitis. media.  Acute in f la m m a ti o n in  < 3 we e ks (m o n t h)  Often associat e d with respir a tory in f ecti o n  M o st com m on reason. mi d dle e a r. a vir a l u p p e r. for me d ical. t h er a py. for chil d ren you n g e r th a n 5 years.

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Acute

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  1. Acute otitis media Acuteinflammationin < 3 weeks(month) Oftenassociatedwith respiratoryinfection Most commonreason middle ear a viralupper formedical therapy forchildrenyoungerthan 5years Recurrentotitis media: Atleast4episodes/year Atleast3episodes/6months (with adequatetherapy)

  2. Epidemiology childrenhave atleast one episodeof (byage 3,50-85%) incidenceage6-15months Most AOM Peak Increasedincidencein thefall and winter Only20% areadults >700 milion cases/year

  3. Causes Eustachiantubeis lined with respiratory mucosa Respondstogether mucosa with nasopharynx Edema narrowed lumen negativemiddle earpressure > >  Influxofpathogens possible fromnasopharynx is

  4. Causes Inflammatoryresponsein middle theobstruction ear worsens Trigger: Allergies Upperrespiratorytractinfections GER(especiallychildren) Adenoidhypertrophy Other

  5. Causes Viral (30-70%) RSV Rhinovirus Coronavirus Influenza,parainfluenza Bacterial(55%) Streptococcuspneumoniae (44%) Haemophilusinfluenzae(41%) Moraxellacatarrhalis(14%) Gramnegativeentericbacteria S.Aureus Combined(15%) •

  6. Riskfactors Age:<7 TheirEustachiantubes areshort,floppy, horizontaland poorlyfunctioning

  7. Handbookof Pediatric Otolaryngology:APractical Guide forEvaluationand Management of PediatricEar, Nose, andThroatDisorders

  8. Risk factors Geneticpredisposition Eustachiantubedysfunction Allergictendencies Bottle feeding(first3 months) (breastmilkcontains lactoferrin,oligosaccharide andsurfaceimmunoglobulinAthatinhibit bacterialcolonization) (suckinggeneratesnegativepressure) Incorrectposturewhile breastfeeding

  9. Riskfactors Underlyingpathology Unrepairedcleftpalate Parentalsmoking Largefamilys/attendingdaycare Immunocompromisedstates

  10. Signs and symptoms Otalgia(notalways) Fever Hearingloss (speechdelayfor Headache Nausea Cough Rhinitis Conjunctivitis children)

  11. PhysicalExamination Pneumaticotoscopy/otoscopy: Redoropaqueeardrum Retractedeardrum Immobileorhypo-mobileeardrum Presenceoffluidbehindeardrum (purulent,serous,mucoid) Retractionpockets Bullousmyringitis

  12. PhysicalExamination ) Otorrhea(in caseof tympanostomytube,perforation Mastoidtenderness Anteriorlyrotatedpinna Tympanometry Audiometry Inspectionorpharynxand nasalcavity

  13. Diagnosis Acuteonsetof signsand syptoms Thepresenceof middleear effusion (hypomobileeardrum,air-fluidlevel) Signsand symptomsof middle earinflamation (erythema,otalgia)

  14. Complications Acutemastoiditis Abscessformation Facialparalysis Otitismediawith effusion PersistentAOM RecurrentAOM Hearingloss Perforationof eardrum

  15. Complications (rare) Lateralsinusthrombosis Otitichydrocephalus Septicshock Meningitis Encephalitis Extraduralabscess Labyrinthitis

  16. Treatment Antibacterialtherapyfor: Childrenofage<6months 6monthsto2yearswithsevere RecurrentorbillateralAOM Immunocompromisedpatients illness Patientswithaperforatedtympanicmembrane Pain management(Ibuprofen,Diclofenac, paracetamol) Decongestantsand/orantihistamines, nasalsteroids

  17. After 24-48h (48-72h) If noimprovemants: Noantibiotics> antibiotics Antibiotics> changetoadifferentantibiotics

  18. Antibacterialtherapy Amoxicilin750-1500mg/day 50-100mg/kg/day  (hasnotrecivedamoxicilininpast30daysand allergytopenicilin) Amoxicillin-clavulanate875/125mg/day 90/6.4mg/kg/day (alternativeforamoxicilin) Ceftriaxone1-2g/day50mg/kg/dayor Cefuroxim500mg/day30mg/kg/day has no   Azithromycin,clarithromycin,erythromycin caseof allergyto penicilin 5-7-10days in  

  19. RecurrentAOM treatment +Tympanostomy

  20. Non-drugTreatment Myringotomyin caseof sevarepain Tympanocentesisin caseof severepain a diagnosticprocedureif thereis no improvementwith 2ndline ofantibiotics (localanesthesia) (narcosis) and as

  21. Preventive measures Avoidingriskfactorsif possible Vaccination:? S.Pneumonia(PCV-7) Influenza Adenoidectomy Polipectomy • •

  22. Differential diagnosis Otitis externa Impactedcerumenorforeignbodyin ear Tympanosclerosis Otitis mediawitheffusion Injuryof theear

  23. Sources Shapiro,NinaL.HandbookOfPediatricOtolaryngology:APractical GuideForEvaluationAndManagementOfPediatricEar,Nose,And ThroatDisorders.Singapore:WorldScientificPublishingCompany, 2012.eBookAcademicCollection(EBSCOhost).Web.5Mar.2016. https://www.clinicalkey.com.db.rsu.lv/#!/content/medical_topic/21-s2.0- 1014193?scrollTo=%23heading0   http://web.a.ebscohost.com.db.rsu.lv/dynamed/detail?vid=2&sid=74b4f a24-4f97-43f1-a411- 581c0fcc826e%40sessionmgr4003&hid=4204&bdata=JnNpdGU9ZHlu YW1lZC1saXZlJnNjb3BlPXNpdGU%3d#AN=116345&db=dme  https://www.clinicalkey.com.db.rsu.lv/#!/content/book/3-s2.0- B9780323079327000247?scrollTo=%23hl0001072  https://www.clinicalkey.com.db.rsu.lv/#!/content/book/3-s2.0-  B9780323280471005540 http://www.aafp.org/afp/2007/1201/p1650.html  http://journals.plos.org/plosone/article?id=10.1371/journal.pone.00362  26 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC153141/ 

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