AOM

1. AOM

2. 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)

3. 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

4. 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

5. Pathogenesis • Impaired eustachian tube function • Negative pressure increases • Nasopharyngeal contents are aspirated into middle ear • Increased vascular permeability: development of MEE

6. Viruses • RSV • Paraflu (types 1,2,3) • Influenza (type A and B) • Adenovirus • Coronavirus

7. Bacteria • Streptococcus Pneumoniae • Nontypeable Hemophilus influenza • Moraxella catarrhalis • S. pyogenes (Group A strep) • Staph Aureus (less common)

8. 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

9. Normal TM

10. OME

11. AOM

12. Management • Observation • Treatment

13. 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

14. Antibiotic • High dose amoxicillin: 80-90mg/kg/day • Alternative for penicillin allergy • Augmentin 90mg/kg per day of amox component • Ceftriaxone • Clindamycin

15. Complications • Mastoiditis • Acute labyrinthitis • Petrositis • Meningitis • Brain Abscess • Epidural Abscess • Otitic hydrocephalus