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Special Senses II > CN2: Acute Otitis Media & Externa > Flashcards

CN2: Acute Otitis Media & Externa Flashcards

1
Q

It is the generic term for inflammation within the middle ear (ME) cleft beginning behind an intact tympanic membrane (TM)

A

Otitis Media

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2
Q

What refers to the continuous space that extends from the nasopharyngeal orifice of the eustachian tube to the farthest mastoid process air cells?

A

Middle ear cleft

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3
Q

What refers to the presence of fluid in the ME + the signs and symptoms of acute infection s/a fever, pain, and otorrhea if with TM perforation?

A

Acute otitis media

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4
Q

What is the difference between acute otitis media and otitis media with effusion?

A

In otitis media with effusion, there is presence of fluid in the middle ear but there is absence of signs and symptoms of acute infection

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5
Q

What is one of the most common infections of childhood?

A

Acute otitis media (AOM)

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6
Q

How much is the percentage of children have at least one episode of otitis media before their third birthday?

A

60-70%

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7
Q

AOM generally accompanies any what?

A

URTI (Upper Respi)

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8
Q

AOM’s frequency is much higher in children with what?

A

Cleft palate

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9
Q

What are the risk factors associated w the development of acute otitis media?

A
  • young
  • males
  • race (native americans, canadian indians, genetic factors)
  • poor economic & social conditions
  • szn of the yr (winter/cold - dt schl crowding during URI pd)
  • attendance at a daycare (highest correlation)
  • bottle-feeding (breastfeeding prevents infxns)
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10
Q

The older a person gets, there is decreased incidence of what?

A

URTI; and mature ET anatomy

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11
Q

OM:

Most ear infections occur before the age of 6 d/t:

A
  • maturation effect/changes in immune system
  • maturation of the anatomy of the ET
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12
Q

What is the pathogenesis of AOM

A

ET dysfxn (allergy/inflammation) –> absorption of air in the middle ear –> negative pressure in the middle ear –> exudation of fluid in the middle ear –> trapping of secretion w proliferation of bacteria –> AOM

Almost all inflammation and infection of the middle ear and mastoid are related to a eustachian tube dysfunction

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13
Q

What are the most common causative organisms of AOM?

Usually comes from the nasopharynx through the eustachian tube, usually secondary to upper respiratory tract infection.

A 
S. pneumoniae
H. influenzae
M. catarrhalis
S. pyo
S. au
Viral organisms
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14
Q

What are the symptoms of AOM?

A
  • hearing loss/ear fullness
  • otalgia
  • fever
  • otorrhea if TM perforation
  • vomiting and diarrhea (may occur in young)
  • vertigo (occasionally in adults)
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15
Q

Only slight decrease in hearing noted initially

A

Hearing loss/ear fullness

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16
Q

What usually follows the decrease in hearing, and initially mild in intensity but later progress to severe deep throbbing pain?

A

Otalgia

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17
Q

In infants and toddlers who can’t verbalize yet that experience ____, are irritable and pull at their ears

A

Otalgia

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18
Q

What are the expected otoscopic findings in AOM?

A
  • presence of fluid in middle ear w signs and symptoms of acute infxn
  • red and bulging tympanic membrane w landmarks generally indistinct
  • otorrhea if the tympanic membrane has ruptured; also associated w decrease intensity of pain and pressure
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19
Q

It means drainage of liquid from the ear, and results from external ear canal pathology or middle ear disease with tympanic membrane perforation.

A

Otorrhea

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20
Q

What may aid in the diagnosis by confirming the presence of fluid in the ME?

A

Tympanometry

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21
Q

Not mandatory unless w possible suppurative complications

A

Radiographic imaging

22
Q

This may be performed in the following circumstances:

a. Extreme toxicity or hx of febrile conclusions
b. An immunologically compromised child
c. Failure of antibiotic tx
d. Complications of AOM

A

Tympanocentesis

23
Q

The removal of fluid from behind the eardrum. The doctor uses a special needle with a tube attached to collect the sample of fluid. A culture and sensitivity test is usually done.

A

Tympanocentesis

24
Q

Tx of choice for AOM

A

Antimicrobial therapy
Still the treatment of choice

Antibiotic of choice
Amoxicillin given for 7 to 10 days
TMP-SMZ or erythromycin-sulfisoxazole as alternative antibiotics

Alternative antibiotics
If there is no improvement after 3 days shift to:
- Amoxicillin-clavulanate
- Cefuroxime
- Ceftriaxone

Adjuvant therapy
- Paracetamol for fever and pain
- Antihistamines for those with underlying allergy problems
- Myringotomy
Promptly relieves the severe pain due to AOM but adds little to either remission of inception or clearance of ME effusion
- Otic drops
If with secondary acute otitis media due to otorrhea

25
Q

If there’s no improvement after 3 days, the alternative antibiotics are:

A
  • amoxicillin-clavulanate
  • cefuroxime
  • ceftriaxone
26
Q

Adjuvant therapy in AOM

A
  • paracetamol for fever and pain
  • antihistamines for those w underlying allergy problems
  • myringotomy
  • otic drops
27
Q

Use this if w secondary acute otitis media d/t otorrhea

A

Otic drops

28
Q

Promptly relieves the severe pain d/t AOM but adds little to either infxn or clearance of ME effusion

A

Myringotomy

29
Q

What is a procedure to create a hole in the ear drum to allow fluid that is trapped in the middle ear to drain out. The fluid may be blood, pus and/or water. In many cases, a small tube is inserted into the hole in the ear drum to help maintain drainage:

A

Myringotomy

30
Q

Prevention of AOM

A

Environmental modifications
If risk factors are identified, environmental changes advocated in the child’s environment

Vaccinations
- Viral vaccines
Proof of the concept that viral RTIs either predispose children to bacterial otitis media or cause viral otitis media is provided by studies of the effect on acute immunization with influenza vaccine

  • Bacterial vaccines
    Pneumococcal vaccine
    > Streptococcus pneumoniae is the leading cause of AOM
    > Pneumococcal vaccine effective in decreasing the number of episodes of AOM
  • Haemophilus influenzae vaccine
    Not of use since ~90% of cases was caused by the nontypeable strains
31
Q

Algorithm for mgmt of AOM:

A
  1. Px presenting w decreased in hearing
  2. On otoscopy, is the tympanic membrane red and bulging?
  3. If yes, is there otalgia? fever? concomitant/precedent URTI?
    If no, look for other causes
  4. If yes, AOM
    If no, otitis media with effusion
  5. AOM tx: antibiotic: Amox 7-10 days
    alternative: erythromycin-sulfisoxazole
  6. Is there improvement of symptoms?
    If yes, continue antibiotics 7-10 days
    If no, shift to: co-amoxiclav, cefuroxime, ceftriaxone
  7. Is there improvement of the shift?
    If yes, complete antibiotic
    If no, perform tympanocentesis –> give appropriate antibiotic
32
Q

What is an infxn of the external ear canal confined to the fibrocartilaginous portion of the EAC where the glands and hair follicles are located?

A

Circumscribed otitis externa or furunculosis

33
Q

In severe cases, surrounding cellulitis may extend beyond this area

A

Circumscribed otitis externa or furunculosis

34
Q
  • usually associated w a recent hx of water exposure, e.g., swimming or diving, thus called “swimmer’s ear”
  • occur during hot, humid weather
A

Diffuse otitis externa

35
Q

What are the etiologic causes of circumscribed otitis externa?

A

Staphylococcus aureus or Staphylococcus albus

36
Q

What are the etiologic causes of diffuse otitis externa?

A

Usually Pseudomonas and other G(-) organisms

37
Q

Usually due to trauma from scratching or cleaning the ear

A

Circumscribed otitis externa

38
Q
  • the water macerates the tissues further worsened by attempts to clean the ear afterwards, forming a favorable environment for growth of organisms
  • may also be secondary to otorrhea in cases of acute or chronic otitis media
A

Diffuse otitis externa

39
Q

What are the signs and symptoms associated with furunculosis?

A
  • pain (quite marked dt limited room for expanding edema in area)
  • tenderness on manipulation of pinna or tragus
  • hearing may be decreased in large furuncles
  • purulent ear discharge
  • circumscribed swelling affecting the hairy portion of external auditory canal
40
Q

What are the signs and symptoms associated with diffuse otitis externa?

A
  • severe pain (stroma overlying the bone of the inner third of the EAC is very thin, allowing minimal room for swelling)
  • pain on manipulation of tragus and/or pina
  • scanty ear discharge
  • diffuse swelling of whole ear canal
  • hearing usually not affected unless the swelling obliterates the canal
  • possible presence of tender regional lymphadenopathy
41
Q

What are the expected otoscopic findings in AOE specifically Furunculosis?

A

There is a circumscribed swelling, usually in the hairy portion or lateral portion of the EAC

42
Q

What are the expected otoscopic findings in AOE specifically diffuse otitis externa?

A

The entire canal is swollen

43
Q

Which pain is most severe seen in? OE or OM?

A

Otitis externa

44
Q

In what infxn is tenderness om pinna manipulation present?

A

Otitis externa, absent on om

45
Q

What is the ear canal in OE and OM?

A

OE: swollEn
OM: norMal

46
Q

What is the tympanic membrane in OE and OM?

A

OE: normal or red

OM: PERFORATED OR BULGING

47
Q

Where is fever and hx of URTI usually present?

A

Otitis media

48
Q

History of scratching or Ear clEaning

A

Otitis ExtErna

2Es

49
Q

Hearing status of OE and OM

A

OE: not impaired unless canal obliterated
OM: impaired

50
Q

Mastoid x-ray on OE and OM

A

OE: normal
OM: evidence of mastoiditis

51
Q

Therapeutic Plan for Furunculosis

A
  • mechanical cleaning of crusts, scales, and desquamated debris
  • if pointing or abcess formation occurs, drainage should be established w a needle or knife –> bleeding can be ctrlled w smol cottonballs soaked in antiseptics or topical antibiotics
  • if pointing hasn’t occured yet, local heat, analgesics, and a topical antibiotic can be tried –> cutting to an area at this pt risks damage to the underlying cartilage, causing a secondary perichondritis
52
Q

Therapeutic Plan for Diffuse Otitis Externa

A
  • mechanical cleaning of crusts, scales, and desquamated debris
  • if severely swollen, cotton wick impregnated w topical antibiotic should be placed carefully in the canal and left for 2-7 days or until edema subsides and wick falls spontaneously. Once wick is in place, px or fam should be instructed to saturate the wixk w OTIC DROPS several times a day as prescribed
    a. Prevents closure of canal
    b. Acts as a conduit for steroid otic dps to reach swollen areas
    c. Acts as a stent to prevent further swelling and thus lessen pain
  • in severe cases or if perichondritis or chondritis of the EAC is suspected, systemic drugs considered
    (Usually, systemic antibiotic will be unnecessary in tx of AOE)

Special Senses II (2 decks)

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