Master the board step 3

Infectious Diseases
Otitis Media
Key features include the following:
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Redness
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Bulging
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Decreased hearing
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Loss of light reflex
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Immobility of the tympanic membrane
Although all of the findings above can be present, the most sensitive is the presence
of immobility of the tympanic membrane. If the tympanic membrane
is freely mobile on insufflations of the ear, then otitis media is not present. The
physical exam may also describe the absence of the light reflex.
Diagnostic Testing
There is no radiologic test to confirm the diagnosis, which is based entirely on
physical examination. Patients may complain of decreased or muffled hearing.
Treatment
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Best initial therapy: Amoxicillin. Usual course is 7–10 days; longer for
younger patients and shorter for older patients.
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Next step: Perform the most accurate test, tympanocentesis and aspirate
of the tympanic membrane for culture. This is rarely necessary and is only
done for recurrent or persistent cases that fail therapy.
Basic Science Correlate
Otitis media is caused by swelling of the Eustachian tube. When the
narrowest portion (or isthmus) becomes inflamed, it blocks the egress of
secretions. Pneumococcus, nontypeable Haemophilus, and Moraxella are the
most common causes. Haemophilus vaccine does not prevent the type of
infections that cause sinusitis and otitis. Vaccine prevents only invasive group
B Haemophilus.
CCS Tip: On CCS, advance the clock forward 3 days. If the infection is not
improving, switch the amoxicillin to one of the following:
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Amoxicillin-clavulanate
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Cefdinir
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Ceftibuten
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Cefuroxime
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Cefprozil
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Cefpodoxime
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