AOM in pediatrics

1. OTITIS MEDIATITIS MEDIA
Haya Almousa – medical intern

2. OUTLINEUT
LINE
• Otitis media: Acute otitis media
• Introduction
• Eitology
• Presentation
• Management

4. OTITIS MEDIA (OM)
• OM: is suppurative infection of the middle ear cavity.
• is the 2nd most common disease of childhood, after upper respiratory infection
(URI).
• Rout of spread:
 Eustachian Tube (commonest)
 External Ear
 Blood-borne (rare)
• There are several subtypes of OM, as follows:
• Acute OM (AOM)
• OM with effusion (OME)
• Chronic suppurative OM
• Adhesive OM

6. ETIOLOGYITOLOGY
• Both bacteria and viruses can cause OM.
• Viruses include:
• Rhinoviruses
• Influenza
• Respiratory syncytial virus.
• Bacterial pathogens:
• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis

7. RISK FACTORSISJ FACTORS
Other factors
Factors that help to
spread the infection
External Ear
Factors that help to
spread the infection
Eustachian Tube
Factors that cause
Eustachian Tube
dysfunction
Lack of breastfeedingTraumatic perforation
of the TM
Recurrent URTICraniofacial
abnormalities
Passive exposure to
smoke
Supine baby feedCleft Palate
Day care (increase
exposure to infectious
agents)
Prolonged NGT feed
(Risk of GERD to ear)
Allergic Rhinitis

8. CLINICAL MANIFESTATIONLINICAL
MANIFESTATION
CLINCI

9. CLINICAL MANIFESTATION
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• In infants: symptoms are non-spesific
and include:
• Fever
• Irritbility
• Difficulty sleeping or staying asleep
• pulling one or both ears
• move head side to side.
• Poor feeding
• Otorrhea
• In older children and adolescent:
• Fever
• Otolgia
• Otorrhea

10. EXAMINATION
• General examination.
• Head and neck region:
• Several congenital syndromes,
craniofacial anomalies, and systemic
diseases
• Signs of common cold which can
predispose to acute otitis media.
• Cough, rhinorrhea, or sinus congestion

11. EXAMINATION
• Local: of the external ear and TM.
• Otoscope is standard for clinical diagnosis:
• TM: neutral position pearly gray, translucent,
and unperforated.
• Bulging tympanic membrane (TM)
• Air-fluid level
• Visualization of of purulent material
• Hyperemia of TM
• Loss of light reflex
• Perforated TM

12. OTOSCOPIC EXAMINATION
• In infant and children:
• Save the examination until the
end.
• Show otoscope to the child and
let him/her paly with it.
• Stabilize the child’s head to
prevent movement
• Pull the pinna down.

15. SIGNS OF AOM

18. Diagnosis of AOM requires:
 History of acute onset of signs and symptoms
 Presence of middle ear effusion
 Signs and symptoms of middle ear inflammation
The definintion of AOM includes all of the following:
• Recent, usualy abrupt, onset of signs and symptoms of middle ear
inflammation and middle ear effusion
The presence of middle effusion that is indicted by any of the
 Bulging of the tympanic memebrane
 Limited or absent mobility of the TM
 Air-fluid level behind the TM
 Otorrhea
Signs and symptoms of middle ear inflammation as indicated by either:
 Distinct erythema of the TM.
 Distinct otalgia

19. COMPLICATIONS
• Chronic effusion
• Hearing loss
• Cholesteatoma
• Intracranial extension
• Meningitis
• Subdural abscess
• Venous thrombosis
• Mastoiditis

20. WORK UP
• Laboratory studies:
• Laboratory evaluation is usually unnecessary,
• Imaging studies:
• Imaging studies are not indicated in patients with OM unless intratemporal or
intracranial complications are suspected.
• Tympanocentesis:
• to determine the presence of middle-ear fluid, followed by culture of the fluid to
identify causative pathogens
• Useful in neonates, immunocompromised patients, and patient not responding to
therapy.

21. MANAGEMENT
• Base on the certinty of the diagnosis and severity of the illness.
 Observation (for 48-72 hours)  If symptoms are mild
 Medical treatment 
• Antibiotic: Amoxicillin is the drug of choice (Dose: 80-90 mg/kg/day for 10
days)
• Analgesics/Antipyretics
• Nasal decongestant and antihistamine : are not effective

22. PREVENTION
• Elimination of risk factors.
• Day care attendance
• Tobacco smoke exposure
• Pacifier use
• Breastfeeding for less than 3 months.
• Vaccine
• Antibiotic prophylaxis

23. MANAGEMENT
23
• Amoxicillin 80 – 90 mg/Kg in 2 divided doses
• 3rd day: no improvement  switch to Augmentin same
dose
Severe symptoms + bilateral + age 6 m – 2 y:
• Oral analgesics:
• paracetamol adult 1 g Q 6 Hrs PRN.
• Child 10-15 mg/kg 4 times daily.
Symptomatic:
• Language delay
• Chronic effusion > 3 m.
• Hearing loss
Indications of Grommet tube:

24. REFERENCES

25. THANK YOU