Acute Otitis Media

What is it?
Acute Otitis Media is an infection of the middle ear... usually bacterial, but could also be viral.

Why should you care?
75% of kids get it by the time they are 1 year old - often due to eustachian tube dysfunction (kids have a shorter/more horizontal tubes than adults). You will see lots of this on your pediatric rotation. I'm still in my first week and have seen 7 cases.

3 Main Bugs:
1. Strep pneumo
2. H.Flu
3. Moraxella

Things that can obstruct the eustachian tubes:
1. Enlarged adenoids
2. Allergies
3. Viral infections

Once obstructed:
1. Mucocilliary drainage is impaired
2. Resorption of gases w/in the middle ear that create a vacuum... this pulls bacteria from the nasopharynx into the middle ear which causes a secondary infection

Major risk factors for getting it:
1. Young age
2. Family hx
3. Day care
4. Smoking environment
5. Not breast-feeding (if mom is bottle feeding - be sure to tell her not to prop a bottle up in the crib while the baby is going to sleep and to also use a fully ventilated bottle)

3 Signs Necessary to Diagnose OM:
1. Signs of middle ear effusion
     Usually seen via an immobile tympanic membrane (TM) - use a pneumatic insufflator to check
     *Note - the movement of the TM is very subtle, I couldn't really tell on my first patient.

2. Signs of middle ear inflammation
     Seen as a bulging TM and it is usually discolored
     *Note - it is not always RED, it can be gray or yellow too! I have found that most kids have very waxy ears and it is difficult to see the TM every time -  in addition- Often when kids are screaming, their ear canals will turn bright red anyway-  so don't be fooled!

3. Acute onset of sx related to the ears
     Ear pain (pulling at ears, irritability)

1. Most cases resolve on their own! Only about 10% of cases need antimicrobial.
2. Talk to parents about pain control (tylenol/advil)
3. Options:
     a. Watchful waiting: observe child for 24-48 hrs w/o Rx or provide a safety net Rx for the antimicrobial only to be filled if patient is not better in 24-48hrs
     b. High dose amoxicillin is for when watchful waiting is not appropriate or sx have not improved

*Watchful waiting is appropriate if the kid is > 6m old, they are not having severe illness, fever < 39C, reliable parents (will they follow up if things get worse?)

Hope this helps! I will try to write about things that I see frequently throughout my rotation. I have plenty of stories to share from my first week. Let's just say it has been eventful! Kids are so much fun!

Source: PEDSCASES: Stollery Children's Hospital Podcast

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