HEENT

Question 1

What are the otoscopic criteria for diagnosing AOM in peds?

Answer 1

1. Presence of a middle ear effusion AND inflammation (bulging, red or yellow tympanic membrane with loss of bony landmarks or presence of an air-fluid level).

or

2. Perforated TM

Question 2

What are the criteria for ‘observation’ (defer abx therapy) in AOM in peds?

Answer 2

1. mild symptoms
2. > 6 mo old
3. symptomatic for < 48 hrs

Question 3

What are the criteria for immediate abx in AOM in peds?

Answer 3

1. <6 mo old
2. moderate to severe symptoms (high fever, difficulty sleeping, severe pain, poor feeding)
3. Symptomatic >48 hr
4. Acutely perforated TM
5. Bilateral AOM <2y

Question 4

Name 4 bacteria associated with AOM.

What percentage resolve spontaneously in 72h?

Answer 4

1. Strep pneumonia
2. HFLU
3. Moraxella
4. GAS

80% resolve spontaneously in 72h

Question 5

Name 8 risk factors for AOM

Answer 5

Male

Indigenous race

Daycare attendance

FHx of recurrent otitis media

Parental smoking

Pacifier and bottle use

Cleft palate

Down syndrome

Young age

Immunosuppression

Climate/environmental

Crowded living conditions

Craniofacial abnormalities