AOM/AOE

What is the BIGGEST environmental risk factor for developing AOM?

• Exposure to school-aged children via siblings at home and daycare

• Exposure to second hand smoke

• Socioeconomic status

• Being breastfed

• Sleeping prone

What is the bacterial pathogen that most often causes AOM?

• Streptococcus pneumoniae

• Moraxella catarrhalis

• Group A strep

• Haemophilus influenzae

• Pseudomonas

Answer explanation

Otitis conjunctivitis is almost always secondary to non-typable H-flu. Group A strep is responsible for only 5% of AOM but has a higher risk of causing mastoiditis

What has the highest positive predictive value for a diagnosis of AOM?

• Ear tugging and perceived ear pain on history

• Bulging of the TM

• Erythema and increased vascularity on otoscopic exam

• A retracted TM with bony landmarks more prominent than usual

• Prior history of ear infections

Which eardrum should be diagnosed as AOM?

• 
• 
• 

Answer explanation

You diagnose a 6 month old with acute otitis conjunctivitis. How should you treat?

• Amox 80mg/kg/day divided q12h for 10 days

• Augmentin 90mg/kg/day divided q12h for 10 days

• Watchful waiting

• Amox 40mg/kg/day divided q12h for 10 days

• Amox 80mg/kg/day divided q12h for 10 days

You diagnose a 6 year old with R AOM x1 day. How should you treat?

• Amox 80mg/kg/day divided q12h for 5-7 days; Ibuprofen q6h PRN

• Amox 80mg/kg/day divided q12h for 10 days; Ibuprofen q6h PRN

• Watchful waiting; ibuprofen q6h PRN

• Augmentin 90mg/kg/day q12h for 5-7 days; Ibuprofen q6h PRN

• Only Amox 80mg/kg/day divided q12h for 5-7 days; it's not even that painful

Which of the following is NOT an option in the management of chronic OME (greater than 3 months) with abnromal hearing tests?

• Watchful waiting with repeat hearing tests

• Adenoidectomy and/or tonsillectomy

• Tympanostomy tubes

You are seeing a 5-year-old boy in clinic who received tympanostomy tubes 9 months ago. He has had URI symptoms for 9 days and discharge from his right ear for 6 days. He has been afebrile and not complained of pain, but the discharge is becoming heavier. What is the best treatment option?

• High dose amoxicillin for 14 days

• Urgent referral to ENT

• Topical fluoroquinolone for 7 days

• Augmentin for 10 days

Answer explanation

Topical fluoroquinolones without systemic antibiotics have been shown to be effective in uncomplicated AOM with PE tubes. Topical ofloxacin or ciprofloxacin alone provide clinical cure in 75% of cases of AOM with PE tubes. If the otorrhea is persistent or accompanied by signs of severe infection, systemic antibiotics may be required.

Which of the following is NOT associated with an increased risk of AOE?

• Aggressive removal of cerumen (including use of alkaline ear drops)

• Impacted cerumen leading to trapped fluid

• Swimming in contaminated water

• Eczema and seborrhea leaving debris in the ear canal

• Not showering or bathing for longer than 1 week

Answer explanation

AOE is almost always bacterial, with pseudomonas and staphylococcal being the most common (and often combining)

A 4-year-old girl presents to you with drainage from her left ear accompanied by 2 days of ear pain. Her mother denies any fevers at home. On exam, the tympanic membrane is difficult to see due to a swollen ear canal and the patient is resisting the exam. What is the recommended treatment?

• Topical ofloxacin 3% for 7-10 days

• High dose amox since you can't rule out AOM

• Topical polymyxin/neomycin/hydrocortisone for 7-10 days

• Topical anesthetic drops to reduce swelling and re-examine the ears in 1-2 days

Answer explanation

Topical fluoroquinolones or aminoglycoside combinations (polymyxin/neomycin/hydrocortisone) are equally effective. However, without being able to see this patient's TM, the fluoroquinolones are recommended.