otitis media paeds.pdf otitis management

This is the infection of the middle ear and commonly missed out in paediatric. This presentation will help in management of such cases in a paediatric ward.
Mothers become concerned as they may not know what is troubling their loved children and you once you manage such cases it is a sigh to them

1. OTITIS MEDIA

2. Introduction
oThis is the infection of the middle ear
oOtitis media (OM) is second only to the common cold among
illnesses that bring a child to the physician
oThe peak incidence and prevalence is from 6–20 months of age
oOtitis media figures importantly in the differential diagnosis of
fever
oAccurate definition and diagnosis in infants and young children
often is difficult

3. Epidemiology
oFactors believed to affect the occurrence of OM include:
oAge-more common in those 12-24 months
oGender- Incidence greater in girls but severity greater in boys
oGenetic background-Middle-ear disease is commonly observed
to tend to “run in families,”
oA number of studies have suggested that OM has a heritable
component
oSocioeconomic status- Poverty has long been considered an
important contributing factor to both the development and the
severity of OM-

4. obreast-milk feeding versus formula feeding have found that
breast-milk feeding provides a protective effect against OM
oExposure to tobacco smoke is an important risk factor in the
development of OM
oSeason- highest rates of occurrence of OM are observed during
cold weather months and the lowest rates during warm weather
months
oCongenital Anomalies- Otitis media is universal among infants
with unrepaired palatal clefts, and also is highly prevalent
among children with submucous cleft palate, other craniofacial
anomalies
oPneumococcal Vaccination does appear to have a more
protective effect in limiting frequent OM episodes

5. Clinical features
oSigns and symptoms of AOM are highly variable, especially in
infants and young children
oThere may be evidence of ear pain, often manifested by
oIrritability
ochange in sleeping or eating habits
ooccasionally, holding or tugging at the ear Pulling at the ear,
however, has a low sensitivity and specificity.
oFever also may be present
orupture of the tympanic membrane with purulent otorrhea
oHearing loss

6. oSystemic symptoms and symptoms associated with upper
respiratory tract infections also occur
ooccasionally there may be no symptoms, with AOM discovered
at a routine health examination.
o OME often is not accompanied by overt complaints of the child
but usually is accompanied by hearing loss.
oThis hearing loss may manifest as changes in speech patterns
but often goes undetected if it is unilateral or mild, especially in
younger children.
oBalance difficulties or dysequilibrium also can be associated
with OME, and older children may complain of mild discomfort
or a sense of fullness in the ear

7. Management of acute otitis media
oThe management of AOM should include an assessment of
Pain ( and treat accordingly|)

oObservation without use of antimicrobial agents in a child with
uncomplicated AOM is an option for selected children based on
diagnostic certainty, age, illness severity and assurance of
follow-up

9. Criteria for ABX or observation for AOM
(AAP/AAFP Guidelines Posted March 9, 2004)
Age Certain DX Uncertain DX
< 6 mo ABX ABX
6 mo- 2 yr ABX ABX if severe,
observe if
non-severe
(SNAP?)
> 2 yr ABX if severe
illness, observe
otherwise?

10. Otitis Media Management
•Analgesia
•Observation if appropriate
•If a decision is made to treat
with an antibacterial agent
amoxicillin should be
prescribed for most children
at a dose of 80-90
mg/kg/day.

11. Management
oIf there is no clinical improvement in 48-72 hours
oReassess and confirm or exclude diagnosis of AOM
oIf Observation arm: treat
oIf Treatment arm: Change therapy
oDuration of therapy: 10 days if 2yrs or less or severe 10 days , if
> 2 years 5-7 days

12. Prevention of AOM
oDO
oBreast feeding
oVaccines
oAvoid
oDaycare
oSmoke
oAllergens
oPacifiers
oProphylactic antibiotics

13. FURTHER
READING IS A
MUST