OTITIS MEDIA IN PEDIATRICS SEMINAR PRESENTATION

Otitis media

1. SEMINAR PRESENTATION OF
OTITIS MEDIA
PEDIATRIC WARD

BY: UKASH MUSTEFA
: TASLIMA ISA
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2. OUT LINE
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Introduction
Epidemiology
Etiology
Pathogenesis
Risk factors
Clinical manifestation
Diagnosis
Treatment
Preventions
References

3. INTRODUCTION
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The term otitis media comes from the Latin oto- “for ear,” itis for
“inflammation,” and media- for “middle”.

4. Otitis Media

Otitis Media: An inflammation of the middle ear.

There are 3 subtypes of otitis media:
Acute otitis media,
Otitis media with effusion, and
Chronic otitis media

5. Acute Otitis Media
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
Otitis media is an inflammation of the middle ear.

Acute otitis media involves the rapid onset of signs and
symptoms of inflammation in the middle ear that manifests
clinically as one or more of the following:
Otalgia
Hearing loss
Fever
Irritability.

6. Cont.…
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
Otitis media with effusion differs from acute otitis media in that signs and
symptoms of an acute infection are absent.

Otitis media occurs in all age groups
But is most common in children between 6 months and 2 years of age.

By 3 years of age, up to 85% of children have had at least one episode of otitis
media, Up to 20% have recurrent infections by 12 months of age.

7. Risk factors

The winter season,

Attendance at a daycare center,

Non–breast-feeding in infants

Early age at first infection,

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
Risk factors contributing to increased incidence of AOM include:
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8. Etiology
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
Common bacterial causes
Streptococcus pneumoniae: 20% to 35%.
Haemophilus influenzae: >50%
Moraxella catarrhalis: 20%

Less frequent: Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa

Viral (with or without concomitant bacteria): 44%
Respiratory syncytial virus,
Influenza,
Parainfluenza,
Enteroviruses,
Rhinovirus, and
Adenoviruses

9. Pathophysiology

Nasopharyngeal viral infections impair eustechian tube function  mucosal
inflammation  impairs mucociliary clearance  promotes bacterial
proliferation and infection.

Children are predisposed to AOM because:
Their eustechian tubes are shorter, more flaccid, and more horizontal than
those of adults:
Make them less functional for drainage and protection of the middle ear
from bacterial entry.

Clinical manifestations of AOM are the result of host immune response and
cellular damage from inflammatory mediators such as TNF and IL that are
released from bacteria.
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10. Clinical Presentation
General: The acute onset of Signs and Symptoms of middle Ear infection
following cold symptoms of runny nose, nasal congestion, or cough.
Signs and Symptoms
Ear pain (>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 and, when present, occurs more often
in younger children
Discolored (gray), thickened, bulging eardrum
Pneumatic otoscopy or tympanometry demonstrates an immobile eardrum; 50% of
cases are bilateral
Draining middle ear fluid occurs in less than 3% of patients and usually has a
bacterial etiology.
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11. Acute Otitis Media
Laboratory tests

Gram stain, culture, and sensitivities of ear fluid if draining spontaneously or
obtained via tympanocentesis.
Complications

Infectious: mastoiditis, meningitis, osteomyelitis, intracranial (brain) abscess

Structural: perforated eardrum, cholesteatoma.

Hearing impairment
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12. Treatment

Desired Outcome
The goal of Treatments include:
Reduction in signs and symptoms, eradication of infection
Pain management
Prudent antibiotic use
Secondary disease prevention or Prevention of complications.

General Approach
Differentiate acute otitis media from otitis media with effusion or chronic otitis
media, as the latter two types do not benefit substantially from antibiotic therapy.
Address pain with oral analgesics.
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13. Cont.….

First line

Amoxicillin,
High-dose amoxicillin (80 to 90 mg/kg/day) is preferred over conventional doses
(40 to 45 mg/kg/day)

Amoxicillin /Clavulanate, 1000mg BID for 10 days for adults, 312mg/5ml suspension
P.O. TID for 10 days OR 156mg/5ml suspension P.O. TID for 10 days for children
In cases of severe illness or when coverage for -lactamase - producing organisms
β
is desired,

Alternatives

Sulfamethoxazole + trimethoprim, Adults; 160+800mg. P.O. BID for 10 days,
Children 6-12 years of age; 80+400mg P.O. BID for 10 days, OR
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14. Cont.…

Erythromycin, Adults; 250mg to 500mg P.O. QID, Children; 30-50mg/kg P.O.
QID OR 15-20mg/kg IV Q 4 to 6hours.

Azithromycin
10 mg/kg × 1 day, 5 mg/kg/day × 4 days;
10 mg/kg/day × 3 days;
30 mg/kg single dose
adult dose: 500 mg × 1 day, 250 mg × 4 days

Ceftriaxone 50 mg/kg IM or IV for 1–3 days (max 1g/dose
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15. Chronic Otitis Media

Chronic suppurative otitis media is characterized by persistent or recurrent
purulent otorrhea in the setting of tympanic membrane perforation.

Usually, there is also some degree of conductive hearing loss.

Treatment of chronic active otitis media is surgical;
Mastoidectomy
Tympanoplasty

Can be performed as outpatient surgical procedures
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17. Duration of Treatment and Observation Option
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Duration of treatment
10 days standard [ < 2 years of age , Ethiopia]
5-7 days (short course)
▪Children > 6 years old with mild to moderate disease
Observation without antibiotics for 48-72 hours:
6 months to 2 years, otherwise healthy with non-severe illness at presentation
and an uncertain diagnosis
2 years of age and older without severe symptoms at presentation or with an
uncertain diagnosis

18. Antibiotic Prophylaxis of Recurrent Infections
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Recurrent otitis media is defined as at least three episodes in 6 months
or at least four episodes in 12 months.
Recurrent infections are of concern because patients younger than 3
years of age are at high risk for hearing loss and language and
learning disabilities

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Vaccination against influenza and pneumococcus may decrease risk of
acute otitis media, especially in those with recurrent episodes.
Immunization with the influenza vaccine reduces the incidence of acute
otitis media by 36%.

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21. REFERENCES
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Thank you!Thank you!