Common Ped Ear Conditions

Question 1

What are the most common causes of Otitis Media (organisms)

Answer 1

S. pneumo, H. flu, M. Cat, GAS

Question 2

What are risk factors for devloping an Otitis Media?

Answer 2

Bac colonization, Recurennt viral URIs, smoke exposure, immunocompromised, bottle feeindg, young age, sibling, daycare

Question 3

patient presents with fever, ear pain. upon exam, you see a red bulging TM.

Answer 3

Acute Otits Media

Question 4

patient presents with ear pain. upon examination, you see air bubbles behind the TM. patient recently had a URI

Answer 4

otitis media with effusion

Question 5

Although visual confirmation of otitis media is usually enough, what other methods can be used for diagnosis?

Answer 5

pneumatic otoscopy, tympanometry

Question 6

how is “recurrent” otitis media defined

Answer 6

3 infections in 6 months or 4 in one year

Question 7

What should your first “treatment” be in OM?

Answer 7

WATCHFUL WAITING

Question 8

When is watchful waiting contraindicated?

Answer 8

fever present, ear symptoms greater than 48 hours, children under 2, severe pain not relieved by analgesics.

Question 9

will most OMs get better on their own?

Answer 9

yes, 80%

Question 10

patient presents to clinic, 4 years old. has been digging and tugging at ears. upon exam, you see AOM. What should you do?

Answer 10

watchful wait

Question 11

patient presents, 1 years old, has had fever, AOM and has not seen symptoms improve in over 3 days. what should you do.

Answer 11

abx (amoxiciillin, augmentin, cephalosporins), and pain management (topical drops) if necessary

Question 12

What might a child be at risk for if they have had chronic OMs?

Answer 12

myringotomy tubes. they bypass the obstructed eustachian tubes. They spontaneously fall out in 6-12 months.

Question 13

Patient presents with a cough. Upon your ENT exam, you see bullae on the TM. What organism and what condition are you worrieda bout?

Answer 13

walking pneumonia, mycoplasma

Question 14

Bullous myringitis is caused by what two organisms generally?

Answer 14

strep pneumo or mycoplasma

Question 15

Patient presents with ear infection, you prescribe abx. patient doesnt get better and returns. you notice a red bulging behind the ear. What will you use to diagnose? What are you worried about? what are the complications?

Answer 15

CT scan, mastoiditis,

meningitis
brain abcess
facial palsy

Question 16

Patient presents with ear infection, you prescribe abx. patient doesnt get better and returns. you notice a red bulging behind the ear. how will you treat?

Answer 16

myringotomy for culture and sensitivity. REFER. hospitalize for IV ABX (ceftriaxone, nafcillin or clindamycin)

immediate surgery is needed.

Question 17

What is the most causative organism of Otitis Externa?

Answer 17

P aeruginosa.

Question 18

Mom brings patient in because they are not eating. They pull away when mom tries to touch their ears. On exam you see white exudate in the inflammed canal. What is the treatment?

Answer 18

topical abx ONLY IF TM IS INTACT and acetic acid preps to help dry and kill microbes.

Question 19

Mom brings patient in because they are not eating. They pull away when mom tries to touch their ears. On exam you see white exudate in the inflammed canal. Child has tubes. How do you treat?

Answer 19

quinolone otic drops

Question 20

cerumen is..

Answer 20

sterile and has a bacteriostatic effect

Question 21

how can impacted cerumen be removed by provider?

Answer 21

currettage, lavage, irrigation, suction, cerumenoltyic agents. NEVER QTIPS!

Question 22

What should you do if you try to remove a foreign body but it is not coming out easily?

Answer 22

REFER TO ENT

Question 23

How should you remove a bug from the ear?

Answer 23

oil then try to forcep it out

Question 24

as a follow up to foreign body removal, what might you prescribe?

Answer 24

abx drops.