خب درباره یکی دیگه از عفونت‌های شایع(بخصوص در اطفال). اول درباره Acute otitis media (AOM) و بعدش هم کمی درباره acute otitis externa(AOE) صحبت خواهیم کرد.
➡️ Acute otitis media (AOM)
◾ابتدا definition:
Acute otitis media (AOM) is an acute, suppurative infectious process marked by the presence of infected middle ear fluid and inflammation of the mucosa lining the middle ear space.
▪️درباره AOM اصلا کی باید شک کنیم و چه چیزایی ممکنه تریگر باشن براش:
In adults, an upper respiratory tract infection or exacerbation of seasonal allergic rhinitis often▪️تشخیص رو بر چه اساسی confirm کنیم؟
precedes the onset of AOM. In adults, AOM is typically unilateral and is associated with otalgia (ear pain) and decreased or muffled hearing. The pain may be mild, moderate, or severe. If the tympanic membrane has ruptured, the patient may report a sudden relief of pain, possibly accompanied by purulent otorrhea.
In adults with suspected AOM, the diagnosis is confirmed by the presence of typical features on
otoscopic examination. Key features include:
▫️Bulging tympanic membrane
▫️Reduced mobility of the tympanic membrane when pneumatic pressure is applied (if pneumatoscopy is available).
یه سری علائم دیگه که ممکنه حالا باشن یا نباشن!
Partial or complete opacification of the tympanic membrane.
Erythema of tympanic membrane.
▪️چه پاتوژن‌هایی شایع‌تر هستند:
Common bacteria causing AOM in both children and adults are Streptococcus pneumoniae and Haemophilus influenzae. Group A Streptococcus, Staphylococcus aureus, and Moraxella catarrhalis are less frequent causes.
▪️درباره‌ی انتخاب آنتی‌بیوتیک و... هم رجوع کنید به این چندتا الگوریتم.
◾اگه پرده‌ی تیمپان پاره شده بود چه کنیم؟
In patients with AOM and acute tympanic membrane rupture, some UpToDate authors treat with topical antibiotic ear drops in addition to oral antibiotics, while other authors treat with oral antibiotics alone. If one does choose to treat, agents containing ototoxic medications (eg, aminoglycosides) should be avoided. Water
precautions should be used until there is documented healing of the tympanic membrane.
◾اندیکاسیون‌های ارجاع رو هم بدانیم:
Patients with severe infections, those who are at high risk for severe infection or infection with resistant organisms, or those who fail to respond to second-line therapy should be referred to otolaryngology (ENT).
In addition, patients with recurrent AOM (>2 episodes in a six-month period), persistent hearing loss following AOM, and chronic tympanic membrane perforation following AOM (>12 weeks) should be referred for otorhinology consultation.
▪️یه عارضه مهم که میتونه داشته باشه ماستوئیدیت هست(مجددا بیشتر در اطفال).
Mastoid effusion is seen on computed tomography (CT) in all patients with AOM, but in the vast majority of cases it is not clinically significant. Clinically significant suppurative mastoiditis may present with fever, posterior ear pain and/or local erythema over the mastoid bone, edema of the pinna, or a posteriorly and downwardly displaced auricle.◾یه موردی که ممکنه با AOM اشتباه بشه، Otitis media with effusion(OME) هست.
Any patient with acute suppurative mastoiditis should be admitted to the hospital and started on intravenous (IV) antibiotics, and surgical consultation should be obtained. When suppurative mastoiditis occurs as a complication of AOM, antibiotics with activity against S. pneumoniae and H. influenzae should be given.
An entity that is commonly mistaken for AOM is otitis media with effusion (OME). OME is often characterized by hearing loss and a sense aural fullness. Otoscopy reveals the presence of middle ear fluid without a bulging tympanic membrane or evidence of active infection. In OME, the tympanic membrane is intact
and may or may not be retracted , depending on the chronicity of the effusion.
◽درباره managementش هم به الگوریتم رجوع بفرمایید.