Middle Ear Basic

Question 1

Acute Otitis media - ES cause

Answer 1

ES too small OR ES inflamed shut

Question 2

Age range of eustachian tube growing

Answer 2

Birth - age 2

Question 3

OM w/ diffusion fluid type

Answer 3

Clear

Question 4

AOM - common bacteria

<3 months

Answer 4

E coli

S aureas

Question 5

AOM - common bacteria

3 months - 14 years

Answer 5

S pneumoniae
H influenzae
M catarrhalis

Question 6

AOM - common bacteria

>14 yrs

Answer 6

• S pneumoniae
• GAS (group a hemolytic strep)
• S aureus

Question 7

Most frequent dx in sick children + most common antibio administration reason

Answer 7

Acute otitis media

Question 8

Peak incidence AOM

Answer 8

6-18 months old

Question 9

PCV 7 / 13 vaccines treat only

Answer 9

Strep pneumo

Question 10

Risk factors for AOM

Answer 10

Smoke, pollution

Day care, family exposure

Question 11

AOM presentation

Answer 11

OTALGIA, +/- OTORRHEA

Headache, apathy

Question 12

AOM signs

Answer 12

fever, irritability, poor feeding

Question 13

AOM = BC vs. AC?

Answer 13

BC>AC

Question 14

Gold standard for AOM dx

Answer 14

pneumatic otoscopy

Question 15

Good extra support evidence for AOM dx?

Answer 15

URI

Question 16

AAP Dx
AOM , 6-12yo
Guidelines?

Answer 16

New otorrhea (w/o AOE)
Mod-Severe TM bulge
Mild TM bulge + otalgia
Mild TM bulge + TM erythema

Question 17

AOM differential

Answer 17

AOE, OME, ETD, Cholesteatoma

Question 18

AOM Tx general

Answer 18

Reduce pain

Antibio vs. watchful wait

Question 19

AOM Tx

6 months-23 months

Answer 19

Severe - ABX
Not severe - ABX bilateral
-decide unilateral

Question 20

AOM Tx

>24 months

Answer 20

Severe = ABX

Not severe = decide

Question 21

AOM first line ABX

Answer 21

Amoxicillin 80-100mg/kg/day every 12 hrs x 10days
Amoxi clavulanate (augmentin)

Question 22

AOM 2nd line ABX

Answer 22

Cefnidir
Cefuroxime
10 days
3RD gen cephalosporins

Question 23

AOM 3rd line ABX

Answer 23

Azithromycin Z pack or single (x3)

Ceftriaxone

Question 24

Follow up: when to suspect OME?

Answer 24

<2 yrs old + 8-12 weeks

>2yrs old + learning/language problems

Question 25

AOM red flags

Answer 25

* Red swelling behind ear * Spread bilateral in infant * Persistent high grade (103) fever

Question 26

Mastoiditis TX

Answer 26

Ceftriaxone IV | Mastoidectomy

Question 27

Bullous Myringitis Tx

Answer 27

ABX

Question 28

Recurrent AOM infxn Tx

Answer 28

(W/in 15 days of tx completion) | Change to Ceftriaxone or Levaquine

Question 29

Chronic Otitis Media P.E.

Answer 29

TM perf Polyps Choesteoma

Question 30

Chronic Otits Media Tx

Answer 30

Long term aural ABX | Sometimes oral ABX