37.2 Outer and Middle Ear Conditions Flashcards
ddx for conductive hearing loss?
wax exostoses foreign body atresia stenosis
otitis externa caused by 2 main things?
bacteria: pseudomonas/staph aureus
fungal
presentation of otitis externa?
smelly
painful to move the pinna
-discharge
management of otitis externa?
- swab MCS
- stay on side for 5-10 minutes
- sofradex
- keep it dry
- topical drops
otitis externa fungal? presentation?
- candida, aspergillosis
- can see black dots.spores
- not painful
- itchy
drops for fungal otitis externa?
if drum intact: locacortin-viofrom drops -kenacomb drops -nilstat drops -Need Rx for 3 weeks
management of ear wax?
nothing if no problem
- ceruminolytics
- syringing: no if perforation or if only hearing ear
- aural toilet
foreign body in ear: bug?
drown it in olive oil
direct/syringe
foreign body in ear: bead?
- suction
- glue in stick
- wax curette
glue ear definition?
CHRONIC Otitis media with effusion:
>3months or more
risk factors for chronic Otitis media with effusion?
season: fall-winter FHx -URTI -cleft palate -child care centres
likely cause of chronic Otitis media with effusion?
biofilm
how to find out if fluid in middle ear?
pneumatic otoscopy
which retraction pockets are dangerous?
posterior: damage to ossicles through erosion from vibration - like sand paper
- Manage with grommets
what to remember with kids with resolved chronic Otitis media with effusion?
check in a few months for any retraction pockets
how old to use the otovent?
age 6 usually
how does otovent work?
positive pressure in post nasal space, pushes air up the eustachian tube
steroids for chronic Otitis media with effusion?
NOPE
grommets, any discharge through them?
no, should allow drainage into eustachian tube
chronic Otitis media with effusion and adenoidectomy?
research divided
-age 4-8 might benefit with grommets
glue ear and flying?
- need to be careful - might have rapid expanding air from pressure changes
- can use ear planes
- suck lollipops/milk
peaks of incidence for acute otitis media?
6-12 months
4-5 years
management of acute otitis media?
- 60% of patients pain-free within 24 hours, give pain relief
- review in 2-3 days: if pain no settled: give antibiotics
how long to use Abx for acute otitis media?
8-10 days
exceptions for acute otitis media treating with ABx?
- children under 2
- cochlear implant
- unlikely to come back for follow up
complications of acute otitis media?
- facial palsy: urgent grommet
- mastoiditis
what is considered recurrent acute otitis media?
3 or more in past 6 months
what is myringoplasty?
grafting ear drum
mastoiditis Rx?
- if early, Abx
- send to hospital
when to refer for acute otitis media?
- chronic, more than 3 months
- suspect cholesteatoma
- hearing loss
what is cholesteatoma?
squamous cells bundle
what does congenital cholesteatoma look like?
white pearl behind intact ear drum
cholesteatoma formation?
- retraction pocket
- chronic discharge for year
- MUST refer
classic presentation of cholesteatoma?
middle ear infection, chronic, due to pocket
dangers of cholesteatoma?
- erode through bone and nerves
- brain abscess
treatment of choice worldwide for severe cholesteatoma?
modified radical mastoidectomy
big cholesteatoma surgery in australia
combined approach tympanoplasty
otitis externa bacterial presentation and treatment?
swollen canal smelly painful Rx ciloxin Sofradex for 1/52
otitis externa fungal presentation and treatment?
spores white blotting paper Rx locacortin oviform drops kenacomb nil stat 1/12
