Otitis Media

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Slide 1 :

Otitis Media By James A. Yost, M.D., MS, M.B.A. Emory Family Medicine

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Otitis Media Acute Chronic Definition Epidemiology Risk Factors Microbiology Complications Diagnosis Treatment

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Otitis Media Otitis Gr. otos, ear, + itis, inflammation Media Referrs to the middle portion of the ear Definition any inflammation of the middle ear without reference to etiology or pathogenesis

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Acute Otitis Media

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Acute Otitis Media Definition Onset less than 3 weeks Epidemiology In the U.S. 20,000,000 cases of AOM are estimated to occur each year. By age 12 months, 66% of all children have had at least one episode of AOM By age 3 years, 46% of children had 3 or more episodes of AOM

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Acute Otitis Media Epidemiology cont. 2nd most common disease of Childhood the most common cause for childhood visits to a physician's office Highest incidence of AOM occurs between 6 and 24 months of age much less common after 7 years of age

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Acute Otitis Media Risk Factors Day care Winter months Craniofacial anomalies Congenital or acquired immune dysfunction Eustachian tube dysfunction Ciliary dysfunction Allergies Cigarette smoke and air pollution Nasal obstruction

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Acute Otitis MediaBugs!! Bacteria S. pneumoniae (35%) H. influenzae (25%) M. catarrhalis (15%) Gram negative enteric bacteria (25%) Viruses Respiratory syncytial virus Adenovirus Rhinovirus Influenza virus

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Acute Otitis Media Complications Persistent middle ear effusions 40% have effusion at one month 20% at two months 10% at three months Hearing loss (conductive and sensory) TM perforation

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Acute Otitis Media Complications cont. Chronic suppurative otitis media Atelectasis Cholesteatoma Tympanosclerosis Mastoiditis Meningitis Labyrinthitis

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Acute Otitis Media Diagnosis Otalgia Ear tugging Otorrhea Hearing loss Fever, irritability, anorexia, N/V, diarrhea, lethargy, headache Tinnitus, vertigo

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Acute Otitis Media Diagnosis cont. Physical exam with an otoscope: Opacity Bulging TM Erythema Middle ear effusion (MEE) Decreased mobility with pneumatic otoscopy

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Acute Otitis Media

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Acute Otitis Media

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Acute Otitis Media

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Acute Otitis Media

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Acute Otitis Media Treatment The ABCDEFs of treating AOM Amoxicillin/Augmentin Biaxin/Bactrum Cephalosporins Diet/hydration Erythromycin Fever control

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Chronic Otitis Media Definition Greater than 3 months Chronic serous otitis media may be defined as a middle ear effusion, having the nature of serum Chronic suppurative otitis media is a middle ear effusion having an agent producing pus formation

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Chronic Otitis Media Epidemiology 39 cases per 100,000 persons in children and adolescents aged 15 years and younger 8% of American Indians 12% of Eskimos

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Chronic Otitis Media Risk Factors A history of multiple episodes of AOM Living in crowded conditions Day care facility attendance Being a member of a large family Ciliary dysfunction Chronic Allergies Cigarette smoke and air pollution Nasal obstruction from adenoids

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Chronic Otitis Media Bacteria P. aeruginosa (40%) S. aureus (20%) Klebsiella (20%) Anaerobes are found in 50% of cases

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Chronic Otitis Media Diagnosis A common presenting complaint is hearing loss in the affected ear Fever or vertigo The external auditory canal may or may not be edematous and typically is not tender. The discharge of purulent, and cheeselike to clear and serous.

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Chronic Otitis Media Diagnosis cont. Granulation tissue often is seen The middle ear mucosa may be edematous or even polypoid, pale, or erythematous. CT scan or MRI

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Chronic Otitis Media

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Chronic Otitis Media

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Chronic Otitis Media Treatment Chemoprophylaxis Myringotomy and tubes: 4 episodes of AOM in six months 6 episodes a year Or no response to treatments Adenoidectomy Pneumococcal vaccines

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Chronic Otitis Media Treatment cont. Topical antibiotic drops containing aminoglycosides Intranasal or systemic decongestants Systemic antihistamines Systemic or intranasal steroids

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Chronic Otitis Media

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Chronic Otitis Media

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Chronic Otitis Media Myringotomy tubes.wmv Click here for a video of a myringotomy

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