otitis media canadian way, Schemes and Mind Maps of Medicine

Download otitis media canadian way and more Schemes and Mind Maps Medicine in PDF only on Docsity! Otitis Media 1. CAUSES OF THE DISCHARGING EAR ACCORDING TO THE TYPE OF DISCHARGE PRESENT Collected by Ana Otitis externa Infected perforation/grommets Chronic suppurative otitis media Infected cholesteatoma Foreign bodies Trauma or cerebrospinal fluid leak latrogenic cause/surgery Acute otitis media/chronic suppurative otitis media Cholesteatoma Trauma Tumours — external auditory canal tumour — glomus tumour — middle ear tumour 2. CAUSES OF THE DISCHARGING EAR ACCORDING TO THE SITE OR ORIGIN OF DISCHARGE External auditory canal * Otitis externa ¢ Trauma ¢ Dermatological conditions ¢ Tumours . Collected by Ana Middle ear ¢ Acute otitis media/chronic suppurative otitis media * Cholesteatoma ¢ latrogenic causes ¢ Trauma ¢ Tumours  Figure 1. Algorithm for diagnosis of otitis media VOUS Me Senet MUR URL mm OR Um Cg erforation (hole ir ve SBR) Leer eT ECR UON I} a perforation (hole in earc aT USC eg 10a ae and document: gh), with no of p drum mobility siz ” elit A 8 ae OCT [pneumatic otoscopy] and tympan Ls) Cate [gee] CMe tat) Collected by Darius Peep ‘AOM, acute otitis media; CSOM, chronic suppurative otitis media; OME, otitis media with effuison. Reproduced with permission from Department of Health. Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations. Canberra: DoH, 2011. Available at www. health.gov.au/internet/ publications/publishing.nst/Content/oatsih-otis-media-toc~Algorithms [Accessed 27 November 2015].  Figure 4. Management of otitis media® Yes No ' No | Yes ' Yes [to Collected by Darius Reproduced with permission from The Royal Children’s Hospital Melbourne. Acute otitis media. Parkville, Vic: RCH, 2015. Available at www.rch.org.au/clinicalguide/ guideline_index/Acute_Otitis_Media [Accessed 16 December 2015].  Figure 6. Management of otitis media in high-risk populations AOM with perforation i] ith amoxycillin 50-90 mg/kg/day for at least 1 week CUM et CN iI " OM IcclaniumUosel Reales all limel\ULcUrlCRelO ne <eer\) of AOM in last € i Cate ON tec} pisodes in 5 Add topical antibiotics after 4—7 ys (eg ciprofloxacin [Coles MTeoR ON AL mopping} eMac i CTe eC ee CO BYisColUisisn0) 1p Comodo oN CaTe EE) antibiotics @ a "i " (amoxycillin COMER cae en) sem tet lI) ¢ Discharge through 7 Te present for >6 weeks despite appropriate treatment for AOM AOM, acute otitis media; CSOM, chronic suppurative otitis media. Reproduced with permission from Department of Health. Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations. Canberra: DoH, 2011. Available at www.health.gov.au/internet/publications/publishing.nsf/Conten/ catsih-otitis-media-toc~Algorithms [Accessed 16 December 2015]. CHRONIC OTITIS MEDIA There are two types of chronic suppurative otitis media and they both present with deafness and discharge without pain. The discharge occurs through a perforation in the TM: one is safe (see FIG. 50.10a), the other unsafe (see FIG. 50.10b). © Chronic discharging otitis media (safe)” Collected by Afeaneh treatment can be with and following ear toilet. The toileting can be done at home by dry mopping with voll ea Seah If persistent, referral to exclude cholesteatoma or chronic osteitis is advisable. Recognising the unsafe ear Examination of an infected ear should include and the roof of the external auditory canal immediately above it. A perforation here renders the ear ‘unsafe’ (see FIG. 50.1); other perforations, not involving the drum margin (see FIG. 50.2), are regarded as ‘safe’.  Acute Otitis Media All of: 1. presence of middle ear effusion 2. presence of middle ear inflammation 3. acute onset of symptoms of middle ear effusion and inflammation Epidemiology + 60-70% of children have at least 1 episode of AOM before 3 yr of age * 18 mo-6 yr most common age group = 22% of children in this age range will develop AOM in the first wk of a viral URI + one third of children have had >3 episodes by age 3; peak incidence January to April Etiology + S. pneumoniae: 32% of cases (decreasing since the introduction of PCV7 and PCV 13) = H. influenzae (non-typeable): >50% of refractory AOM e M. catarrhalis: 14% of cases — less virulent » GAS * viral - more likely to spontaneously resolve » less common - anaerobes (newborns) , Gram-negative enterics (infants) Predisposing Factors + Eustachian tube dysfunction/obstruction = swelling of tubal mucosa: URTI, allergic rhinitis, chronic rhinosinusitis = obstruction/infiltration of Eustachian tube ostium: adenoid hypertrophy (not due to obstruction but by maintaining a source of infection), barotrauma (sudden changes in air pressure) = inadequate tensor palatini function: cleft palate (even aft r repair) « abnormal Eustachian tube: gentic syndromes such as DS, Crouzon, Apert + disruption of action of cilia of Eustachian tube: Kartagener’s syndrome, CF * immunosuppression/deficicncy duc to chemotherapy, stcroids, DM, hypogammaglobulincmia, CF Risk Factors « prolonged bottle feeding, while laying down and/or shorter duration of breast feeding = pacifier use second hand smoke crowded living conditions (day care/group child care facilities) or sick contacts family history of otitis media orofacial abnormalities immunideficiency « ethnicity - First Nations and Inuit = for recurrent AOM: lower levels of secretory IgA or persistent biofilms in the middle ear Pathogenesis « obstruction of Eustachian tube - air absorbed in middle ear > negative pressure (an irritant to middle ear mucosa) — edema of mucosa with exudate/effusion — infection of exudate from nasopharyngeal secretions Diagnosis * most important criteria for AOM is a bulging TM (all children with bulging TM had AOM and only 8% of children with non-bulging TM had AOM) - Reference: Shaikh N, Hoberman A, Rockette HE, Kurs- Lasky M 2012 Management Ist line « amoxicillin 75-90 mg/kg/d divided into two doses: safe, effective, and inexpensive. Use high doses to overcome MIC for penicillin binding proteins (method of resistance) = if penicillin allergic: macrolide (clarithromycin, azithromycin - high resistance), trimethoprim- sulphamethoxazole (Bactrim’) ¢ 2nd line = amoxicillin-clavulanic acid (Clavulin’) = cephalosporins: cefuroxime axetil (Ceftin’), ceftriaxone (Rocephin’), cefaclor (Ceclor’), cefixime (Suprax*) » AOM deemed unresponsive if clinical signs/symptoms and otoscopic findings persist beyond 48 h of antibiotic treatment = use second line treatment for otitis-conjunctivitis syndrome (AOM with bacterial conjunctivitis) because H. influenzae and M. catarrhalis are more likely pathogens which are Beta lactamase producing, so Amoxil is ineffective * symptomatic therapy: antipyretics/analgesics (e.g. acetaminophen), deconges ants (may relieve nasal congestion but does not treat AOM) * prevention: parent education about risk factors, pneumococcal and influenza vaccines, surgery (e.g. tympanostomy tubes) = choice of surgi al therapy for recurrent AOM depends on whether local factors (Eustachian tube dysfunction) are responsible (use ventilation tubes), or regional disease factors (tonsillitis, adenoid hypertrophy, sinusitis) are responsible Complications « extracranial: hearing loss and speech delay (secondary to persistent middle ear effusion), TM perforation, extension of suppurative process to adjacent structures (mastoiditis, petrositis, labyrinthitis), cholesteatoma, facial nerve palsy, middle ear atelectasis, ossicular necrosis, vestibular dysfunction ¢ intracranial: meningitis, epidural and brain abscess, subdural empyema, lateral and cavernous sinus thrombosis, carotid artery thrombosis