what causes AOM?
- organisms
- position of eustachian tube
- strep, h. flu, moraxella (common)
- GAS, staph, gram neg bacilli, mycoplasma (less common)
- sterile effusions
what are risk factors for AOM?
- day cares
- bottle feeding (positioning)
- smokers in house
- AOM in first year of life predisposes to more down the road
SSxs of AOM?
- throbbing pain (or maybe NO pain)
- fever
- decreased hearing
- n/v
- moodiness, irritability
- child tugs on ear
PE findings of AOM?
- bulging, red or cloudy TM
- possible fluid line on TM
- decreased mobility on pneumatic otoscopy
complications of AOM?
- OM w/effusion most common
- if bilateral= hearing loss and may be speech delay
- mastoiditis used to be common
- perforation of TM is common but not serious unless peripheral
- may persist during abx tx or relapse w/in 1 mo
if TM perforates what will the pt experience? if perforation is peripheral what should you check for?
- perforation= discharge & sudden loss of pain
- peripheral= check regularly for cholesteatoma
what does chronic otitis media include?
- otitis media with effusion
- chronic supprative otitis media
what is chronic otitis media with effusion (OME)? what causes it?
- effusion in middle ear
- incomplete resolution of acute OM or due to inflammation
risk factors for OME?
- prior t-tube placement
- allergy
- adenoid hypertrophy
- summer or fall
SSxs for OME?
- hearing impairment
- mild otalgia, tends to be worse at night
- may have overlapping of common cold
PE findings for OME?
- amber or gray intact TM but usu retracted or in neutral position
- impaired mobility of TM
- bubbles or air/fluid level may be seen
- chronic cervical LA
what is the course of OME?
- if persists becomes COME
- fluid behind intact TM
- risk of infxn
- recurrent AOM and/or perforation
what is chronic supprative otitis media? what causes it?
-chronic inflammation of middle ear for at least 6 weeks w/TM perforation & otorrhea
what are causes of CSOM?
- acute OM resulting in performation
- trauma
SSxs of CSOM?
- hearing loss
- chronic purulent d/c
- painless
PE findings of CSOM?
- perforation of TM
- may see retraction pocket in posteriorsuperior quadrant, cholesteatoma, granuloma, polyps
what is the course of CSOM?
- may have perforation w/o sxs, but sometimes chronic bac infxn develops
- chronic persistent infxns can destroy parts of ossicles leading to conductive hearing loss-child= delayed intellectual development
what is the diagnostic criteria for AOM?
- acute onset
- middle ear effusion
- limited or absent TM mobility
- air-fluid level behind membrane
- SSx of middle ear inflammation
diagnostic criteria for persistent AOM?
-persistent SSxs during abx tx or relapse w/in 1 mo of tx completion
diagnostic criteria for OME?
-fluid behind intact TM in absence of features of acute infxn
diagnostic criteria for COME?
-persistent fluid behind intact TM in absence of acute infxn
diagnostic criteria for CSOM?
- persistent inflammation of middle ear or mastoid cavity
- recurrent or persistent otorrhea through perforated TM
what is myringitis? what causes it?
- inflam or infection of TM, primary/secondary, acute/chronic forms
- primary causes: mycoplasma pneu, TM trauma, acute bullous or hemorrhagic myringitis, fungal, eczema, granulosa
- secondary causes: AOM, AOE, COM, COE
SSxs of myringitis?
- serosanguinous otorrhea, otalgia, hearing impairment
- if acute: sudden ear pain 24-48 hrs, fever
