Otitis media basic concepts

It is an inflammation of the middle ear. The diagnosis includes signs and symptoms of infection of the middle ear, such as otalgia, fever, and irritability, as well as the presence of fluid in the middle ear.
Most nonspecific upper respiratory tract infections have a viral,not bacterial, etiology and tend to resolve spontaneously. Otitis media is most common in infants and children.

1. OTITIS MEDIA - Therapeutics Dr. S P Srinivas Nayak , Assistant Professor, SUCP Hyderabad, Telangana 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

2. OTITIS MEDIA It is an inflammation of the middle ear . The diagnosis includes signs and symptoms of infection of the middle ear, such as otalgia , fever, and irritability, as well as the presence of fluid in the middle ear. Most nonspecific upper respiratory tract infections have a viral,not bacterial, etiology and tend to resolve spontaneously. Otitis media is most common in infants and children. H. influenzae and M. catarrhalis , S. pneumoniae . 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

3. Risk factors Winter season/outbreaks of respiratory influenza virus Attendance at day care centers Lack of breast-feeding in infants Early age of first diagnosis Nasopharyngeal colonization with middle ear pathogens Genetic predisposition Siblings in the home Lower socioeconomic status Exposure to tobacco smoke Use of a pacifier Male gender Immunodeficiency Allergy Urban population 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

4. 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

5. 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

6. 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

7. PATHOPHYSIOLOGY Acute bacterial otitis media usually follows a viral upper respiratory tract infection that causes eustachian tube dysfunction and mucosal swelling in the middle ear. Bacteria that colonize the nasopharynx thus enter the middle ear and are not cleared properly by the mucociliary system. In the presence of effusion, the bacteria proliferate and cause infection. Children tend to be more susceptible to otitis media than adults because the anatomy of their eustachian tube is shorter and more horizontal, facilitating bacterial entry into the middle ear. 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

8. 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

9. CLINICAL PRESENTATIONS General The acute onset of signs and symptoms has cold symptoms of runny nose, nasal congestion, or cough Signs and symptoms Pain that can be severe (more than 75% of patients), Children may be irritable, tug on the involved ear, and have difficulty sleeping , Fever is present in less than 25% of patients , Examination shows a discolored (gray), thickened, bulging eardrum Draining middle ear fluid occurs (less than 3% of patients) that usually reveals a bacterial etiology Laboratory tests Gram stain, culture, and sensitivities of draining fluid or aspirated fluid if tympanocentesis is performed 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

10. 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

11. Treatment Acetaminophen or a nonsteroidal antiinflammatory drug (NSAID) such as ibuprofen should be offered early to relieve pain and malaise in acute otitis media regardless of the use of antibiotics First Line Amoxicillin high dose alone or combined with clavulonic acid. 50–90 mg/kg/day divided twice daily 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

12. Pencillin allergy cases Cefdinir 14 mg /kg /day once or twice daily Cefuroxime 30 mg/kg / day divided twice daily Cefpodoxime 10 mg/kg / day once daily Cefprozil 30 mg /kg /day divided twice daily Azithromycin 10 mg/kg/day IM/IV for 3 days day 1, then 5 mg /kg /day for days 2–5 Clarithromycin 15 mg /kg /day divided twice 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

13. TREATMENT FAILURE CASES Amoxiclav if plane Amoxicillin is given Ceftriaxone 50 mg /kg /day IM/IV for 3 days Other Alternatives: Clindamycin 30–40 mg/kg /day in 3 divided doses tympanocentesis 6/4/2021 Dr. S P NAYAK MED EASY LECTURES

14. Thank you 6/4/2021 Dr. S P NAYAK MED EASY LECTURES