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P50 Pediatrics
Infectious Diseases
Toronto Notes 2019
Otitis Media with Effusion
Definition
• presenceoffluidinthemiddleearwithoutsignsorsymptomsofearinfection
Epidemiology
• mostcommoncauseofpediatrichearingloss
• notexclusivelyapediatricdisease
• followsAOMfrequentlyinchildren
• middleeareffusionshavebeenshowntopersistfollowinganepisodeofAOMfor1moin40%of
children, 2 mo in 20%, and >3 mo in 10%
Risk Factors
• sameasAOM
Clinical Features
• conductivehearingloss±tinnitus • fullness–blockedear
• ±pain,lowgradefever
• otoscopyofTM
■ discolouration – amber or dull grey ■ meniscus fluid level behind TM
■ air bubbles
■ retractionpockets/TMatelectasis
■ flat tympanogram
■ most reliable finding with pneumatic otoscopy is immobility
Treatment
• expectant:90%resolveby3mo
• documenthearinglosswithaudiogram(seeOtolaryngologyFigure16BandFigure17B,OT10)
• nostatisticalproofthatantihistamines,decongestants,antibioticscleardiseasefaster
• surgery:myringotomy±ventilationtubes±adenoidectomy(ifenlargedoroninsertionofsecondsetof
tubes after first set falls out)
• ventilationtubestoequalizepressureanddrainear
Complications of OME
• hearingloss,speechdelay,learningproblemsinyoungchildren
• chronicmastoiditis
• ossicularerosion
• cholesteatomaespeciallywhenretractionpocketsinvolveparsflaccida • retractionoftympanicmembrane,atelectasis,ossicularfixation
Gastroenteritis
• seeGastroenterology,P36
HIV Infection
• seeInfectiousDiseases,ID27