T in 40 Minutes.pptVIP

Pediatric ENT in 40 Minutes Gil C. Grimes, MD Assistant Professor Family Medicine Texas AM HSC COM Scott and White Family Medicine Residency April 6th 2005 Objectives Describe criteria for diagnosing Acute Otitis Media Describe rationale for therapy for Acute Otitis Media Describe Therapy for Serous Otitis Media Describe the role of Tympanostomy Tubes Describe the strategies for diagnosing Strep Pharyngitis Describe Treatment options for Strep Pharyngitis My Bias I am a minimalist If the evidence for intervention is not good I do nothing Acute Otitis Media A diagnosis of AOM requires a history of acute onset of signs and symptoms the presence of middle ear effusion (MEE) signs and symptoms of middle-ear inflammation. Acute Otitis Media The presence of MEE that is indicated by any of the following: Bulging of the tympanic membrane Limited or absent mobility of the tympanic membrane Air-fluid level behind the tympanic membrane Otorrhea Acute Otitis Media Signs or symptoms of middle-ear inflammation as indicated by either Distinct erythema of the tympanic membrane or Distinct otalgia discomfort clearly referable to the ear(s) and interference with or precludes normal activity or sleep Acute Otitis Media Otitis Media? Yes No Acute Otitis Media Otitis Media? Yes No Acute Otitis Media Prevalence Prevalence 10% US children diagnosed by 3 months 90% by 2 years (1) Prospective cohort of children (2) 62% with AOM by 1 year 83% with AOM by 3 years 9th most common diagnosis during FM visits(3) Coded 3.2% visits (3) Acute Otitis Media Etiology Viral pathogens found Tympanocentesis and Nasal Aspirate in AOM RSV and coronavirus RNA in 75%?children 5% dual viral infections Bacterial pathogens detected 62% Viral RNA detected in 57%?bacteria-negative and 45%?bacteria-positive samples Acute Otitis Media Etiology Bacteria shifts Streptococcus pneumoniae S. pneumoniae is the most common bacterial organism identified non-typeable Haemophilus influenzae H. flu identified