2- Midle Ear

Question 1

What is acute otitis media

Answer 1

bacterial infection of middle ear

Question 2

What are potential reasons for bacteria getting caught in the middle ear

Answer 2

Eustachian tube obstructed by mucus s/p URI

Poor eustachian tube drainage (young age, inflammation, congenital defect)

Question 3

What bacteria cause acute otitis media

Answer 3

Strep Pneumo and H. Influenza!!

(if recurrent, probs due to allergies or secondhand smoke

Question 4

How does acute otitis media present clinically

Answer 4

otalgia
pressure
hearing loss
fever
URI Sx

Question 5

What does a TM look like in acute otitis media

Answer 5

immobile, bulging

Question 6

What organism are bullae associated with

Answer 6

Mycoplasma infection

Question 7

What are signs of a perforated TM

Answer 7

Previous pain, now resolved but with drainage

Question 8

How do you treat acute otitis media

Answer 8

Amoxicillin first (2-3 days for improvement)
-Cephalosporin if PCN allergy)

Question 9

What is amoxicillin doesn’t work after 2-3 days

Answer 9

high dose amoxicillin-clavulanate or cephalosporin

Question 10

What antibiotic would you give with a perforated TM

Answer 10

Ofloxacin, it is not ototoxic

Question 11

What are important patent education pieces to give your patient

Answer 11

don’t bottle feed laying down

Pneumo vaccine

Question 12

What are potential complications of acute otitis media

Answer 12

labrynthitis
hearing loss
mastoiditis

Question 13

When and who is acute otitis media most common in

Answer 13

kids 4-24, esp. those sucking on pacifier

fall and winter

Question 14

What did Feirstein say abx tx should be for acute otitis media

Answer 14

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)

Question 15

What causes chronic otitis media

Answer 15

recurrent acute otitis media

Question 16

What will you see on chronic seborrheic otitis media exam

Answer 16

chronic otorrhea
perforated TM
conductive hearing loss

Question 17

What is treatment for chronic seborrheic otitis media

Answer 17

remove infected debris, use earplugs, topical/oral and

TM repair surgically

Question 18

What is serous otitis media in ADULTS

Answer 18

Eustachian tube blocked for long time fluid to go into the middle ear
More common in kids because they have shorter eustachian tubes

Question 19

What is the cause of serous otitis media

Answer 19

S/p URI, barotrauma, chronic allergies

Question 20

How does serous otitis media present clinically

Answer 20

conductive hearing loss
fullness
NO acute illness/edema

Question 21

What will you see on serous otitis media physical exam

Answer 21

HYPOmobile TM, bubbles behind TM
TM bulging or retracted
conductive hearing loss

Question 22

How can you treat serous otitis media

Answer 22

decongestants
anti-histamine
nasal steroids
vent tubes if resistant

Question 23

What is a cholesteatoma

Answer 23

a type of chronic otitis media characterized by prolonged eustachian tube dysfunction creating a keratin sac in the middle ear

Question 24

What is a secondary cause of cholesteatoma

Answer 24

pseudomonas or proteus

Question 25

How does cholesteatoma present clinically

Answer 25

hearing loss and ear drainage

Question 26

What will you see on cholesteatoma PE

Answer 26

TM pocket/TM perforation exuding debris

Question 27

How do you treat a cholesteatoma

Answer 27

abx drops | surgical removal

Question 28

What are complications of cholesteatoma

Answer 28

erosion into inner ear, facial nerve, or brain abscess

Question 29

What is Eustachian tube dysfunction

Answer 29

When the normally closed tube connecting ear to nasopharynx develops negative pressure (edema, or air trapped inside)

Question 30

What causes eustachian tube dysfunction

Answer 30

Viral URI, allergies

Question 31

What are symptoms of eustachian tube dysfunction

Answer 31

fullness fluctuating hearing pan with pressure change popping/cracking

Question 32

What will you see on PE with eustachian tube dysfunction

Answer 32

TM retraction | DECREASED TM mobility

Question 33

How do you treat eustachian tube dysfunction

Answer 33

decongestant autoinflation desensitization intranasal corticosteroid

Question 34

What should patients with eustachian tube dysfunction avoid while symptomatic

Answer 34

air travel altitude change underwater diving

Question 35

What are eustachian tube dysfunction patients more at risk for

Answer 35

otitis media

Question 36

What is otic barotrauma

Answer 36

When you can't equalize pressure in the middle ear with altitude change causing TM rupture

Question 37

What causes otic barotrauma

Answer 37

poor eustachian tube function d/t mucosal edema or congenital narrowing

Question 38

What Sx will you see with otic barotrauma

Answer 38

otalgia, more on descent than ascent | patient education to auto inflate during descent

Question 39

How do you treat otic barotrauma

Answer 39

systemic decongestant before take off | topical nasal decongestant 1 hr before descent

Question 40

What if otic barotrauma persists after landing

Answer 40

decongestants autoinflation Myringotomy PE tubes

Question 41

What can occur if divers descend too quickly

Answer 41

Hemotympanum | Perilymphatic fistula; oval window rupture, sensory hearing loss, vertigo, vomiting

Question 42

How do you heal a TM perforation

Answer 42

small perforations heal on their own | Large perforations require tympanoplasty

Question 43

What should you NEVER use with a TM perforation

Answer 43

ototoxic ear drops (ahminoglycosides) | also don't let water in