ch 89 highlights

Question 1

to diagnose AOM you must have

Answer 1

1) acute onset of signs and symptoms
2) middle ear effusion or If TM is ruptured, purulent otorrhea
3) middle ear inflammation

Question 2

less than 6 mos with a clear or unclear diagnosis of AOM

Answer 2

Start abx

Question 3

6 mos to 2 years with a certain dx

Answer 3

Abx

Question 4

6 mos to 2 years with an uncertain dx

Answer 4

Abx if severe, obs if not severe

Question 5

2 years or older with certain dx

Answer 5

abx if illness is severe

obs if not severe

Question 6

2 years old or older with uncertain dx

Answer 6

obs regardless of severity

Question 7

first line treatment for AOM

Answer 7

high dose Amoxicillin

Question 8

Treatment for AOM if pt has PCN allergy not severe

Answer 8

cephalosporin

• cefdinir
• cefuroxime

Question 9

Treatment for AOM if pt has severe PCN allergy - urticaria or anaphalaxis

Answer 9

azithromycin

clarithromycin

Question 10

pain mgmt for mild to moderate pain with AOM

Answer 10

tylenol/motrin

Question 11

pain mgmt for moderate to severe pain with AOM

Answer 11

codein

Question 12

For children older than 5 with an intact TM, 2013 AAP guidelines also recommend

Answer 12

topical anesthetics such as procaine or lidocaine drops for pain relief

Question 13

severe AOM illness

Answer 13

moderate to severe otalgia greater than 48 hours

fever of 39C (102.2) or higher during the preceeding 48 hours

Question 14

second line AOM

Answer 14

Augmentin or Rocephin

Question 15

who is at an increased risk for developing resistant AOM

Answer 15

Daycare
younger than 2 years
ABX in prior 1-3 mos
Winter and spring season

Question 16

once you start amox when do you escalate care

Answer 16

wait 48-72 hours

if no improvement, start augmentin

Question 17

prevention of AOM

Answer 17

Breastfeed for at least 6 mos
avoid child care esp during resp
Eliminate exposure to 
   tobacco smoke
   reduce use of pacifier in second 6 mos - unproved
   Avoid supine bottle feeds - unproved
   Vaccines - flu and pneumococcal (PCV)

Question 18

what constitutes recurrent AOM

Answer 18

3 + ear infections within 6 mos

4+ ear infections within 12 mos

Question 19

management of recurrent AOM

Answer 19

3) prevention and treatment of flu
4) Placement of tympanostomy tube

really just 3 and 4

Question 20

treatment of AOM with tympanostomy tubes (regardless of TM )

Answer 20

ciprodex (ciprofloxacin/dexmethasone

ciprofloxacin/flucinolone acetonine (Otovel)

Question 21

fluid in middle ear without evidence of local or systemic infection

Answer 21

otitis media with effusion (OME)

Question 22

otitis media with effusion (OME)

Answer 22

can have hearing loss but no pain

resolves without treatment

persists for weeks to months after AOM has resolved

may proceed or follow an episode of AOM

often occurs with URI

not bacterial

Question 23

Acute Otitis Externa (AOE)

Answer 23

inflammation of external auditory canal (EAC)

AKA swimmers ear

Bacterial infection

Abrasion or moisture makes you more susceptible

Question 24

When should you expect improvement for an AOE

Answer 24

improvement in 3 days

better in 10

Question 25

uncomplicated AOE

Answer 25

2% solution of acetic acid

Alcohol with acetic acid helps with drying

Question 26

if more extensive infection or topical does not help the AOE

Answer 26

topical abx
3 drug combo
fluoroquinolone/glucocorticoid which would be (ciprodex (ciprofloxacin/dexmethasone

Question 27

if infection has spread beyond the EAC you will need

Answer 27

systemic abx in addition to topical
Adults - ciprofloxacin - can cause tendon rupture in younger than 18
children - cephalexin (keflex)

Question 28

how can you prevent dizziness when using ear drops

Answer 28

warm them

Question 29

if severe edema

Answer 29

use a ear wick
add drops to tip of wick
change every 48 hours

Question 30

Bacteria of EAC invade the mastoid/temporal with P.aeruginosa

pt has severe otic pain
purulent drainage from ear
granulation tissue in ear

Answer 30

Necrotizing otitis externa (NOE)

Question 31

who is at high risk for NOE

Answer 31

older people with DM

people who are immunocompromised , esp HIV

Question 32

pts with NOE should also receive what treatment

Answer 32

antipseudomonal ear drops (ofloxacin solution)
with
oral ciprofloxacin

Question 33

severe NOE should progress to

Answer 33

IV antipseudomonal therapy

Question 34

Otomycosis

Answer 34

fungal otitis externa

Question 35

intense pruritus
erythema
with/without pain
with/without hearing loss

Answer 35

Otomycosis

Question 36

treatment for Otomycosis

Answer 36

cleansing and application of 2% acetic acid solution 3-4 times/day for 7 days

if does not help

1% clotrimazole (lotrimin) BID x 7 days

if does not help

Itraconazole (sporanox) and fluconazole (Diflucan)

Question 37

eye meds and ear meds

Answer 37

eye form cipro can go in ears but ear form cant go in eyes

Question 38

drugs that are ototoxic

Answer 38

neomycin

polymixin

Question 39

If there is no drainage, can you assume no tm rupture

Answer 39

yes

Question 40

antibiotic used for H.influenzae and M.catarrhalis

alt?

Answer 40

high dose augmentin

IM or IV ceftriaxone and oral clindamycin

Question 41

child > 5 with continued pain even with motrin what else can you prescribe

Answer 41

Aurodex drops

Question 42

fluid in middle ear without localized or systemic infection

Answer 42

OME