2- Midle Ear Flashcards
What is acute otitis media
bacterial infection of middle ear
What are potential reasons for bacteria getting caught in the middle ear
Eustachian tube obstructed by mucus s/p URI
Poor eustachian tube drainage (young age, inflammation, congenital defect)
What bacteria cause acute otitis media
Strep Pneumo and H. Influenza!!
(if recurrent, probs due to allergies or secondhand smoke
How does acute otitis media present clinically
otalgia pressure hearing loss fever URI Sx
What does a TM look like in acute otitis media
immobile, bulging
What organism are bullae associated with
Mycoplasma infection
What are signs of a perforated TM
Previous pain, now resolved but with drainage
How do you treat acute otitis media
Amoxicillin first (2-3 days for improvement) -Cephalosporin if PCN allergy)
What is amoxicillin doesn’t work after 2-3 days
high dose amoxicillin-clavulanate or cephalosporin
What antibiotic would you give with a perforated TM
Ofloxacin, it is not ototoxic
What are important patent education pieces to give your patient
don’t bottle feed laying down
Pneumo vaccine
What are potential complications of acute otitis media
labrynthitis
hearing loss
mastoiditis
When and who is acute otitis media most common in
kids 4-24, esp. those sucking on pacifier
fall and winter
What did Feirstein say abx tx should be for acute otitis media
Observation (abx if same or worse in 2-3 days): 6mo-2yo with unilateral, mild sx, OR, 2+yo if uni/bilateral and not severe
Immediate abx: <6 mo, OR, <24 mo and severe (pain 2+ days, Temp >102.2, bilateral)
What causes chronic otitis media
recurrent acute otitis media
What will you see on chronic seborrheic otitis media exam
chronic otorrhea
perforated TM
conductive hearing loss
What is treatment for chronic seborrheic otitis media
remove infected debris, use earplugs, topical/oral and
TM repair surgically
What is serous otitis media in ADULTS
Eustachian tube blocked for long time fluid to go into the middle ear
More common in kids because they have shorter eustachian tubes
What is the cause of serous otitis media
S/p URI, barotrauma, chronic allergies
How does serous otitis media present clinically
conductive hearing loss
fullness
NO acute illness/edema
What will you see on serous otitis media physical exam
HYPOmobile TM, bubbles behind TM
TM bulging or retracted
conductive hearing loss
How can you treat serous otitis media
decongestants
anti-histamine
nasal steroids
vent tubes if resistant
What is a cholesteatoma
a type of chronic otitis media characterized by prolonged eustachian tube dysfunction creating a keratin sac in the middle ear
What is a secondary cause of cholesteatoma
pseudomonas or proteus
How does cholesteatoma present clinically
hearing loss and ear drainage
What will you see on cholesteatoma PE
TM pocket/TM perforation exuding debris
How do you treat a cholesteatoma
abx drops
surgical removal
What are complications of cholesteatoma
erosion into inner ear, facial nerve, or brain abscess
What is Eustachian tube dysfunction
When the normally closed tube connecting ear to nasopharynx develops negative pressure (edema, or air trapped inside)
What causes eustachian tube dysfunction
Viral URI, allergies
What are symptoms of eustachian tube dysfunction
fullness
fluctuating hearing
pan with pressure change
popping/cracking
What will you see on PE with eustachian tube dysfunction
TM retraction
DECREASED TM mobility
How do you treat eustachian tube dysfunction
decongestant
autoinflation
desensitization
intranasal corticosteroid
What should patients with eustachian tube dysfunction avoid while symptomatic
air travel
altitude change
underwater diving
What are eustachian tube dysfunction patients more at risk for
otitis media
What is otic barotrauma
When you can’t equalize pressure in the middle ear with altitude change causing TM rupture
What causes otic barotrauma
poor eustachian tube function d/t mucosal edema or congenital narrowing
What Sx will you see with otic barotrauma
otalgia, more on descent than ascent
patient education to auto inflate during descent
How do you treat otic barotrauma
systemic decongestant before take off
topical nasal decongestant 1 hr before descent
What if otic barotrauma persists after landing
decongestants
autoinflation
Myringotomy
PE tubes
What can occur if divers descend too quickly
Hemotympanum
Perilymphatic fistula; oval window rupture, sensory hearing loss, vertigo, vomiting
How do you heal a TM perforation
small perforations heal on their own
Large perforations require tympanoplasty
What should you NEVER use with a TM perforation
ototoxic ear drops (ahminoglycosides)
also don’t let water in
