Chapter 37 - Ear Infections Flashcards
Essentials to Dx AOM
moderate to severe bulging TM or new otorrhea not associated with OE
Mild bulging of TM and <48hr otalgia or erythema of TM
Middle ear effusion must be present (pneumatic otoscopy or tympanometry)
Diagnosis of AOE
rapid onset (<48 hr) of Sx (pain OOP to exam, exacerbate with palpation of tragus, pinna)
ear canal inflammation (erythema, edema, drain)
Other sx: plugged feeling, EAC swelling, debris
Bugs causing AOM
S Pneumo (35-40%), H Flu (30-35%), Moraxella (15-20%)
Percentage of AOM bacteria susceptible to amoxicillin
80%
Pathogenesis of OE
disruption of protective mechanisms
Remove cerumen, traumatize ear canal with q tip, fingernail, ear plugs, or foreign body
Moist, humid environment also weakens skin barriers
98% of AOE is bacterial
Function of cerumen
bacteriostatic slightly acidic (also aids in inhibiting infection) barrier to moisture
2 most common OE bugs
S Aureus, Pseudomonas
How to protect yourself from getting OE
acidifying ear drops prevent water exposure to EAC remove obstructing cerumen (by an ENT) dry ear canal with hair dryer (cool setting) avoid direct ear canal trauma
What causes eczema of the EAC with OE?
drainage
Chronic Otitis Externa: definition
otorrhea with sx of OE
>6 wk
May occur after inadequate treatment of OE
Malignant Otitis Externa: patient, complications, sx
Infection of skull base may be after acute or chronic OE
Elderly, DM, Immunocomp
May spread intracranially
Deep stabbing ear pain worse with head motion, otorrhea, fever, loss of voice, dysphagia, facial weak
Complications of OE
MOE
facial cellulitis
irritation of skin of ear/neck
Treatment of OE
debride the debris, restore normal pH, topical antimicrobial, remove causative agent
Fluoroquinolone drops
Systemic if systemic sx present or spread outside ear canal
Drops for pre/post swimming in pt with recurrent OE
2-3 drops of 1:1 solution white vinegar and 70% ethyl alcohol
Bullous myringitis: bugs, hearing changes
virus, S Pneumo, Staph
May cause CHL
Tx bullous myringitis
If viral- analgesic, antiinflamm
If signs of bacterial- topic or oral ABx
Risk factors for otitis media
younger patient colonization of NP with otitis pathogens URI smoke exposure bottle feeding time of year/daycare attendance genetics
Bony vs Cartilage eustachian tube
Bony 1/3 nearest to middle ear
Cartilaginous 2/3 closer to nasopharynx
(opposite of EAC, where 1/3 cartilage, 2/3 bony)
Muscles associated with ET
salpingopharyngeus, TT, TVP, LVP
How otitis media occurs
middle ear under constant negative pressure
When ET is dysfunctional, its unable to equalize the pressure, so fluid builds up, gets infected
Eustachian tube in children
flat, less rigid, shorter
2 most common mastoiditis pathogens
S Aureus, S Pyogenes
What is a biofilm?
groups of bacteria residing in extracellular matrix
matrix resistant to ABX penetration
bacteria share resistance genes and defense mechanisms
In middle ear and nasopharynx, shed plaktonic bacteria, induce inflammation
When to use augmentin for AOM
failed amoxicillin after 48-72 hr
has had amoxicillin in last 30 d
otitis conjunctivitis syndrome (more likely non-type H Flu)
Meds other than amoxil/augmentin for AOM
Ceph - if penicillin sensitive not severe
Bactrim, Clinda, Macrolide - if severe penicillin sensitive
IM Ceftriaxone- fail oral therapy
Which patients can you decide to not use ABX for with AOM?
Over 6 mo, may observe 2-3d if minimal sx, “wait and see”
How bottle feeding can lead to ear infections
If baby lying flat and you prop the bottle –> fluid can enter the eustachian tube
vacuum (neg pressure) created by sucking bottle can transmit to middle ear (doesn’t happen with breast feed)
Dosing of drugs for AOM: Amoxicillin, Augmentin, Cefdinir, Cefuroxime, Cefpodoxime, Ceftriaxone, Clinda
Amoxil- 80-90mg/kg/day BID Augmentin- 90mg/kg/d Cefdinir- 14mg/kg/day 1-2 doses Cefuroxime- 30mg/kg/d BID Cefpodoxime- 10mg/kg/d ID Ceftriaxone- 50mg IM or IV per day 1-3d Clinday 30-40mg/kg/d, TID
Treatment after initial AOM ABx fail (2-3d)
Augmentin
Ceftriaxone
Or: Clinda, tympanocentesis
How long can OME persist after AOM?
3-6 mo (90% resolve by 3mo)
Per one study, does pacifier use increase or decrease AOM risk?
Decrease
Which additional illness combined with AOM episodes would warrant an immune evaluation
pneumonia
When to test hearing in OME
when lasts >3mo
earlier if risks of language delay
How long to ear tubes last? What pushes them out?
on average, 6-12mo
desquamation of epithelial layer of TM
What is CSOM (chronic suppurative otitis media)? How do you treat?
inflammation of mastoid and middle ear for at least 6wk
may be due to cholesteatoma, perforated TM, ventilation tubes
topical drops - ofloxacin, dry ear precautions, address allergy/adenoids
