ch 89 highlights Flashcards
to diagnose AOM you must have
1) acute onset of signs and symptoms
2) middle ear effusion or If TM is ruptured, purulent otorrhea
3) middle ear inflammation
less than 6 mos with a clear or unclear diagnosis of AOM
Start abx
6 mos to 2 years with a certain dx
Abx
6 mos to 2 years with an uncertain dx
Abx if severe, obs if not severe
2 years or older with certain dx
abx if illness is severe
obs if not severe
2 years old or older with uncertain dx
obs regardless of severity
first line treatment for AOM
high dose Amoxicillin
Treatment for AOM if pt has PCN allergy not severe
cephalosporin
- cefdinir
- cefuroxime
Treatment for AOM if pt has severe PCN allergy - urticaria or anaphalaxis
azithromycin
clarithromycin
pain mgmt for mild to moderate pain with AOM
tylenol/motrin
pain mgmt for moderate to severe pain with AOM
codein
For children older than 5 with an intact TM, 2013 AAP guidelines also recommend
topical anesthetics such as procaine or lidocaine drops for pain relief
severe AOM illness
moderate to severe otalgia greater than 48 hours
fever of 39C (102.2) or higher during the preceeding 48 hours
second line AOM
Augmentin or Rocephin
who is at an increased risk for developing resistant AOM
Daycare
younger than 2 years
ABX in prior 1-3 mos
Winter and spring season
once you start amox when do you escalate care
wait 48-72 hours
if no improvement, start augmentin
prevention of AOM
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)
what constitutes recurrent AOM
3 + ear infections within 6 mos
4+ ear infections within 12 mos
management of recurrent AOM
3) prevention and treatment of flu
4) Placement of tympanostomy tube
really just 3 and 4
treatment of AOM with tympanostomy tubes (regardless of TM )
ciprodex (ciprofloxacin/dexmethasone
ciprofloxacin/flucinolone acetonine (Otovel)
fluid in middle ear without evidence of local or systemic infection
otitis media with effusion (OME)
otitis media with effusion (OME)
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
Acute Otitis Externa (AOE)
inflammation of external auditory canal (EAC)
AKA swimmers ear
Bacterial infection
Abrasion or moisture makes you more susceptible
When should you expect improvement for an AOE
improvement in 3 days
better in 10
uncomplicated AOE
2% solution of acetic acid
Alcohol with acetic acid helps with drying
if more extensive infection or topical does not help the AOE
topical abx
3 drug combo
fluoroquinolone/glucocorticoid which would be (ciprodex (ciprofloxacin/dexmethasone
if infection has spread beyond the EAC you will need
systemic abx in addition to topical
Adults - ciprofloxacin - can cause tendon rupture in younger than 18
children - cephalexin (keflex)
how can you prevent dizziness when using ear drops
warm them
if severe edema
use a ear wick
add drops to tip of wick
change every 48 hours
Bacteria of EAC invade the mastoid/temporal with P.aeruginosa
pt has severe otic pain
purulent drainage from ear
granulation tissue in ear
Necrotizing otitis externa (NOE)
who is at high risk for NOE
older people with DM
people who are immunocompromised , esp HIV
pts with NOE should also receive what treatment
antipseudomonal ear drops (ofloxacin solution)
with
oral ciprofloxacin
severe NOE should progress to
IV antipseudomonal therapy
Otomycosis
fungal otitis externa
intense pruritus
erythema
with/without pain
with/without hearing loss
Otomycosis
treatment for Otomycosis
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)
eye meds and ear meds
eye form cipro can go in ears but ear form cant go in eyes
drugs that are ototoxic
neomycin
polymixin
If there is no drainage, can you assume no tm rupture
yes
antibiotic used for H.influenzae and M.catarrhalis
alt?
high dose augmentin
IM or IV ceftriaxone and oral clindamycin
child > 5 with continued pain even with motrin what else can you prescribe
Aurodex drops
fluid in middle ear without localized or systemic infection
OME
