OME (otitis media with effusion)



OME (otitis media with effusion)

|AOM(acute otitis media) | |

|-sterile (non-infectious) secretory otitis media, secondary to a viral URTI|-acute bacterial infection of the middle ear secondary to a viral URTI, |

|-aural fullness with mild hearing loss due to E tube occlusion and |often after OME |

|absorption of air |-bulging TM / opaque |

|-prominent appearance of manubrium and short process with retraction of ear|-ruptured eardrum |

|drum |-pus accumulation in middle ear |

|-fluid and air bubble are visible |-thickened eardrum with erythema (hyperemia) |

|-reduced TM-mobility |-distorted (dullness) / absent light reflex |

|-accumulation or serous effusion in the middle ear |-reduced TM-mobility |

| |-may lead to TM perforation or rare complications |

| | |

|-swelling and destruction of the mucosa in the URT, including E tube | |

|-E tube dysfunction (ETD) |-bacterial infection of the middle ear |

|ETD => absorption of air from middle ear => |-initial viral URTI |

|retraction of TM and accumulation of sterile effusion |-swelling and destruction of the mucosa of the URT, including E tube |

|-hear loss, ear popping, gurgling sound (common in child) |-E tube dysfunction (ETD) |

|-don’t treat with antibiotics yet |-secondary bacterial infection in the middle ear (NPH flora): |

|-may develop into AOM |Streptococcus pneumoniae / Hemophilus influenzae |

|-chronic OME = may have to be treated with ear tube to avoid serious |Moraxella catarrhalis |

|complication |-pus accumulation and increase pressure in the middle ear |

| |-painful and fever |

|(Chronic OME and Complication): |-AOM is common in young children (peak age 2) |

|-permanent hearting loss and learning difficulties |-spontaneous rupture of TM = common complication |

|-tympanosclerosis |-AOM leads to OME in the healing stage |

|-perforation of the ear drum |-very slow healing (6 to 8 weeks) |

|-retraction pockets | |

|-cholesteatoma: |(early signs): OME sign |

|skin cyst grows into the middle ear and mastoid |(1) immobile and retracted TM |

|cyst is not cancerous but can erode tissue and cause destruction of the ear|(2) moderate erythema of the TM / clear fluid and air bubble in ME |

|/ benign epidermoid tumor | |

|(presentation of cholesteatoma): |(consecutive signs): AOM sign |

|hearing loss / facial paralysis / dizziness / imbalance / vertigo |(1) formation of yellow, purulent effusion |

|slow erosion into the brain cavity / intracranial complication risk |(2) increased middle ear pressure |

| |(3) bulging eardrum |

|-OME is the most common cause of conductive hearing loss in children |(4) intense pain |

|(hearing loss dominates as the main symptom) | |

|-OME cause milder earache |(AOM complication): |

|-OME is a harmness and self-limiting condition in most cases |-extracranial (intratemporal) complication: |

|-conservative treatment is suggested |(1) acute mastoiditis = infection of mastoid air cells |

|-treatment of B/L chronic OME = myringotomy / grommets |(2) facial palsy (paresis) |

| |(3) labyrinthitis = light-headedness / loss of balance / nausea |

| | |

| |-intracranial complication: |

| |(1) meningitis = nuchal rigidity / photophobia / headache |

| |(2) brain abscess = ICU brain surgery |

| |(3) neurological deficit symptoms (increased DTR) = spinal cord |

| |(4) venous thrombosis of lat / sigmoid venous sinus = vessels |

| |-occur in patients with cholesteatoma |

| |(early symptoms): |

| |high fever => meningism => change consciousness => death |

| | |

| |-two most common complications to AOM |

| |perforation of the eardrum / chronic AOM or chronic OME |

| | |

| |-Bullous myringitis : |

| |results from viral infection / may accompany AOM |

| |large vesicles and bullae visible on the drum / TM is red |

| | |

| |-AOM causes intense otalgia |

-sensory nerves in ear:

posterior roots of spinal nerves C2 / 3 and CN 5, 7, 9, 10

tensor tympani (CN 5:3) / stapedius mm (CN7) / CN 7 travels through temporal bone = referred pain cause earache

|URTI |SORE THROAT |

|(common URTI symptoms and signs): |(bacterial pharyngitis): |

|-rhinitis = swelling of nasal mucosa and nasal obstruction |is diagnosed clinically by typical symptoms such as dysphagia and sore |

|-conjunctivitis / coryza / rhinorrhea / pharyngitis / tonsillitis |throat and physical examination findings of the pharynx |

|-earache / dysphagia / cough / hoarseness / fever / fatigue |-elevated hemoglobin and granulocytosis = bacterial infection |

|-sore throat = odynophagia | |

|-malaise / abdominal pain / vomiting / diarrhea / mouth breathing |(tonsillitis): |

| |likely when the tonsils are swollen and red |

|(bacterial infection): |the exudate indicates bacterial origin and so does intense pharyngeal |

|-bacterial infections tend to spread and cause severe complications |erythema |

|-effective antibiotic treatment is still effective for bacterial infections| |

|-one dominant symptom |(cause of most URTI) = viruses |

|-intense pharyngeal erythema |-viral pharyngitis / tonsillitis tend to be accompanied by additional |

|-purulent discharge (yellow / green / brownish) |symptoms, such as cough, coryza, conjunctivitis (same virus, usually |

|-exudates on tonsil |adenovirus), and general myalgia |

|-fever spike and new symptoms = secondary bacterial infection | |

|-(CBC finding) = neurophilia (neutrophilic granulocytosis = PMN) |-bacterial pharyngitis / tonsillitis = likely caused by GABHS |

|increased CRP (acute bacterial infection) | |

|increased ESR (chronic bac or viral infection) |---------------------------------------------------------------------------|

|TB or osteomyelitis |------ |

|* CRP reacts quickly to infection activity | |

|ESR reacts slowly to infection activity |Streptococcus pneumoniae |

| | |

|(viral infection): |Hemophilus influenzae |

|-many symptoms = generally viral spread in the whole URT | |

|-if cough = viral infection |-G+ve coccus |

|-(CBC finding) = lymphocytosis (or lymphopenia) |-habitat = URT (endogen) |

| |-causes: |

|(lab tests to differentiate viral and bacterial infection): |AOM ,sinusitis , pneumonia |

|(1) rapid streptococcal antigen test = group A beta-hemolytic |meningitis, conjunctivitis |

| |-treatment: |

|(GABHS) |penicillin, fights G+ve cocci |

|(2) bacterial / viral cultures | |

|(3) serologic test = increase titers of pathogen-specific Ab (M & G) |*most common cause of acute meningitis in children |

| | |

|(lab tests for infectious mononucleosis): |-G-ve coccus |

|(1) monospot test = rapid slide agglutination test / heterophile Ab |-habitat = URT (endogen) |

|sensitivity decrease by increasing time |-causes: |

|usually -ve in children less than 6 to 8 years old |AOM 2nd most common |

|(2) serologic test = increase titers of EBV-specific Abs (M &G) |sinusitis 2nd most common |

|(3) lymphocytosis |tonsillitis |

| |pneumonia / CB |

|-SNOUT = only in test with increased sensitivity |conjunctivitis |

|if test is -ve => rule out disease | |

|-SPIN = only in test with increased specificity |*capsulated form = type B |

|if test is +ve => rule in disease |*non-capsulated type causes AOM, sinusitis, conjunctivitis |

| | |

|---------------------------------------------------------------------------| |

|------ |Moraxella catarrhalis |

| | |

|(follicular bacterial skin infections): |Group A beta - hemolytic streptocci (GABHS) |

|follicititis / furuncle / carbuncle | |

| |-G-ve diplocuccus |

|(bacterial skin infection): |-cause = AOM, sinusitis,conjunctivitis |

|impetigo / ecthyma / erysipelas / lymphangitis / cellulitis |-treatment: |

| |same as H influenzae |

| | |

| |-G+ve coccus |

| |-habitat = URT |

| |-causes: |

| |“strep throat” |

| |most common bacterial pharyngitis / tonsiliitis / scalet fever |

| |-age = 5 to 11 |

| |-skin infection = impedigo |

| |cellulitis / necrotizing fascitis |

| |streptococcal toxic shock synd |

| | |

| | |

| | |

| |(strep throat / scarlet fever (GABHS)): |

| |-purulent complication = direct bacterial spread: |

| |peritonsillitis (quinsy) / lymphadenitis / AOM / sinusitis / epiglottis |

| |-non-purulent complication = delayed hypersensitivity rxn: |

| |rheumatic fever (including endocarditis and arthritis) |

| |post-streptococcal glomerulonephritis |

| |PANDAS (pediatric autoimmune neuropsychiatric disorders) |

| |tics / ADHD / OCD |

| |Sydenham’s chorea (irregular contractions that is not repetitive) |

| | |

| |-scalet fever = incubation period 2 to 4 days |

| |complications (otitis media / cervical adenitis ..) |

|(epiglottitis): |(acute bronchiolitis): |

|age = 2 to 12 years |-respiratory syncytial virus (RSV) |

|pathogens = H influenzae type B / Strep pneumoniae / GABHS |-common in winter |

|Candida |-infection of respiratory and ciliated epithelial cells of bronchioles |

|-bacterial / caustic burns and trauma / drooling and retraction |-mucus secretion and submucosal edema |

|-inspiratory stridor / unable to talk or swallow |-critical narrowing and obstruction of small airways |

|-cherry-red epiglottis |-hypoxia = risk for respiratory failure |

|-acute airway obstruction |-age = 2 to 24 months |

| |-TX: supportive treatment of O2. humidified air, chest clapping |

|(croup = larynotracheobronchitis): |rest, clear fluids, bronchodilators, glucocorticoids |

|-viral (parainfluenza virus) / common in fall / after cold viral URTI |-most deaths occurs in infants ................
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