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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