Day 2 - Neuro4 Audiovestibular

Question 1

Observation w/o antibx in child w/ otitis media; Threshold for starting antibx

Answer 1

6 mo.-2 yr. old, questionable dx, illness not severe, appropriate f/u, antibx can be started promptly if worsens; > 2 yr, can be severe but as long as other criteria met fine; Start antibx if not improving by 49 hrs

Question 2

Tx otitis media

Answer 2

High dose ampicillin; If ampicillin resistance, add clavulanic acid or use stronger cephalosporins

Question 3

Red TM w/ vesicles

Answer 3

Bullous myringitis

Question 4

Tx Bullous myringitis

Answer 4

Oral macrolides - arithromycin or clarithromycin (mycoplasma pneumoniae common); Topical analgesics

Question 5

Dx mastoiditis

Answer 5

Complication of acute otitis media; Erythema, edema, tenderness behind ear, external ear displaced; Dx w/ CT scan of mastoid process

Question 6

Acute labyrnthitis p/w (v. Vestibular neuritis)

Answer 6

Acute onset vertigo, n/v, nystagmus; Auditory fx preserved - Vestibular neuritis; Hearing loss assoc. - Labyrnthitis; Single episode (days to weeks), usually preceded by viral URI or OM; Nystagmus horizontal, suppressed with visual fixation, , fast phase away from affected side; Head thrust abnormal (rapid head movement to abnormal side - Unable to maintain visual fixation); Gait abnormality but preserved ambulation; Absence of focal neuro defects

Question 7

Tx Acute labyrnthitis

Answer 7

Spontaneous; Corticosteroid taper; Sx - ONLY 1st 48 hrs, scopolamine, meclizine, metoclopramide, promethazine; Sx tx beyond that point is counterproductive to recovery; Vestibular rehab exercises; > age 65 headache, focal neuro, vascular risk factors, or sustained vertigo - MRI (r/o schwannoma or more serious dx)

Question 8

Choleastoma

Answer 8

overgrowth of desquamated keratin debris in middle ear, may erode semivesicular chain & external ear canal; Conductive hearing loss; Causes - negative middle ear pressure, chronic retraction pockets from eustachian tube dysfunction, or direct growth of epithelium from TM perforation; Assoc. chronic middle ear infx; Grayish white pearly lesion behind TM; Middle ear surgical removal

Question 9

Most common cause of conductive v. sensorineural hearing loss in adults

Answer 9

Conductive - Otosclerosis ; Sensorineural - Presbycusis

Question 10

Tx Ramsey

Answer 10

Herpes zoster oticus; Narcotics analgesics, Oral steroids, anti-viral w/ valacyclovir (highest efficacy) or famciclovir/acyclovir