key: cord-0060749-m2n7x9u0
authors: Domachowske, Joseph; Suryadevara, Manika
title: Otitis, Sinusitis, and Mastoiditis
date: 2020-08-06
journal: Clinical Infectious Diseases Study Guide
DOI: 10.1007/978-3-030-50873-9_6
sha: 700f58f6716742b53ccf4523b75021cd5cc405f1
doc_id: 60749
cord_uid: m2n7x9u0

A 13-month-old immunized female is seen in the pediatrician’s office for evaluation of fever. She was well until one week prior to the office visit, when her illness began with a runny nose and mild cough. Three days prior to the office visit, she developed fevers to 103 ° F, increased fussiness, and difficulty sleeping. On physical examination, she is tired and fussy but not toxic in appearance. Rhinorrhea is present. Her right tympanic membrane is erythematous and bulging, with an effusion present. Pneumatic otoscopy reveals reduced mobility of the tympanic membrane. She is diagnosed with a right acute otitis media and prescribed amoxicillin to cover for the most common causes of AOM including Streptococcus pneumoniae.

.3) 

High dose amoxicillin Amoxicillin-clavulanic acid Cefdinir or Ceftriaxone

If no improvement seen over 48-72 hours, consider changing antibiotics ( Fig. 6 .3).

6.1 Otitis

A 12-year-old immunized boy, with a history of environmental allergies, is seen in the primary care provider's office for fevers and facial pain. He was previously healthy until 2 weeks prior to the office visit when he started with nasal congestion and nighttime cough. These symptoms persisted, and he began to develop low-grade fevers and facial pain. Over the past 2 days, he has had fevers to 102 °F, nasal congestion, facial pain, fatigue, and cough. On physical examination, he appears mildly ill, has significant nasal congestion and purulent rhinorrhea, and has tenderness to palpation of his maxillary sinuses. He is diagnosed with acute rhinosinusitis and prescribed amoxicillin for treatment ( Fig. 6.4 ; Tables 6.4, 6.5 and 6.6).

Predisposing factors* Impede sinus secretion clearance acute bacterial rhinosinusitis Fig. 6 .4 Pathogenesis of acute bacterial rhinosinusitis, *see Table 6 .4 for predisposing factors 

A 6-year-old, immunized female is seen in the Emergency Department for fever and ear pain. She was well until 2 days ago when she developed fevers to 104 °F and left ear pain. Today, the mother noticed swelling behind the ear and brought her in for evaluation. On physical exam, she is mildly ill appearing. Her left tympanic membrane is erythematous, bulging, with an effusion present, and reduced mobility on pneumatic otoscopy. Her left pinna is protruding with erythema, induration, and fluctuance of the postauricular region. A computed tomography scan shows opacification of the mastoid air cells with areas of bony involvement. Treatment with intravenous ampicillin-sulbactam was initiated. She was brought to the operating room for tympanostomy tube placement and surgical debridement. Bacterial cultures of the surgical specimen isolated Streptococcus pneumoniae.

• Suppurative bacterial infection of the mastoid air cells • Secondary complication of AOM • Presents with fever, otalgia, and red, swollen postauricular area • Acute mastoiditis: symptoms <1 month duration • Chronic mastoiditis: symptoms >1 month duration • Diagnosis made clinically, by history and physical • CT scan findings (supporting evidence) -Mastoid air cell opacification -Resorption of the bony septae -Coalescence of air cells (Table 6 .9) 

Clinical Practice Guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years

The diagnosis and management of acute otitis media

IDSA Clinical Practice guideline for acute bacterial rhinosinusitis in children and adults

Pneumococcal infections

1. What are the three clinical elements used to diagnose an acute otitis media? 2. List three possible complications of acute bacterial sinusitis. 3. Match the pathogen to the clinical association. 

1. Acute onset of symptoms, middle ear effusion, signs of inflammation (injected vessels on tympanic membrane, and reduced mobility of the tympanic membrane on pneumatic otoscopy) 2. Periorbital cellulitis, orbital cellulitis, subperiosteal abscess, sinus thrombosis, meningitis, brain abscess, and frontal bone osteomyelitis 3. (a). 4 (b). 1 (c). 2 (d). 3