Disorders of the Ear Flashcards
why are kids more susceptible to ear infections?
their eustachian tubes are more horizontal
what does cerumen do in the ear?
- “washes”- keeps clear of bacteria and microbes
- creates acidic environment (fungus don’t like this)
- vinegar to clean fungus in ear
what is perichondritis? usually due to? Why is it hard to cure?
rare but serious
infection of ear cartilage; usually trauma and pseudomonas; doesn’t respond well to injury b/c bad blood supply
Dx perichondritis vs cellulitis
cellulitis will infect soft tissues as well (ear lobes)
what is otitis externa? Types?
generic term for inflamm disorders of EAR CANAL
- swimmer’s ear (H2O dries out canal, like irritation contact derm )
- often fungal infection
3) . malignant- DM
txt for OE? fungal, bacterial, swimmers
lidocaine to numb then wick to get drops in
fungal: 2%HAc aka half strength vinegar
bacterial- abx w/ anti-inflamm (steroid) OR 2%HAc if pseudomonas
swimmers: alcohol
ceruminosis
excessive cerumen production
what is AOM? what are the three common bugs? usually precipitated by what?
- bacterial infection of the middle ear
- S. Pneumo, M. Cat, H. Flu
- usually preceded by URI (congestion obstructs ET drainage)
what is required to diagnose AOM?
effusion
AOM vs OME in terms of effusion?
AOM: purulent effusion, S/S of inflammation
OME: serous effusion, S/S of inflammation
when looking at TM, Dx of AOM?
mild TM bulge AND ear pain or intense TM erythema
- may respond to POSITIVE pressure on pneumatic otoscopy
- should see altered position of cone of light
those at risk for AOM?
6m-18m males daycare pacifier user parents who smoke bottle-feeder (instead of breast)
what must you document for AOM according to the AAP?
evidence of TM immobility (by tympanogram or pneumatic otoscopy)
a flat Tymp. test result means what?
immobile TM?
meds for AOM: ibuprofen vs tylenol?
ibuprofen: anti-flamm
tylenol: just for pain
when looking at the TM, Dx of OTE?
TM: neutral or retracted
-responds to NEGATIVE pressure on pneumatic otoscopy
2 AOM txt goals
- decrease pain and fever
- prevent developmental delays
most heal spontaneously, if not give abx (75% do well regardless of txt)
Hadley’s “SNAP”
“safety net abx prescription”
tell pt, if symptoms don’t improve w/in 48-72 hrs of the onset of symp, THEN fill Rx
=reduced pointless abx usage
AOM guidelines for txt depend on what 3 pt factors?
when to treat with abx?
severe or nonsevere symptoms
unilateral or bilateral
age
*otorrhea, bilat and severe symp? TREAT w/ Abx
txt abx 1st and 2nd lines for AOM?
1st: Amox
2nd: Augmentin
pt should improve after how many days on abx for AOM?
if they dont?
3 days
if not- give broad spectrum ABX
how long can effusion last for AOM?
12 wks
what can help prevent ear infections?
NOT chemoprophalaxis (no longer reccomended) Vaccines do! against invasive pneumococcal disease (H.Flu) and influenza -tymp tubes
H. Flu txt?
it is BetaLact. resistant. txt w/ augmentin
better name for OME would be? why?
MEE (middle ear effusion)
there is NO infection, fluid is serous
effusion w/out acute symptoms
what meds are of no value for OME?
Abx: b/c it is not an infection
Anti-histamines and decongestants: no longterm value
OME concerns
hearing loss–>effect on speech, language and learning
-at-risk populations need to be evaluated sooner
(young-speech delay, development disorder)
-non at-risk: 3 months is ok to go w/out hearing
primary diagnostic method to distinguish OME from AOM?
pneumatic otoscopy
-tympanometry is an option as well (more expensive)
hearing test guidelines: level of decibels for normal or not normal
0-20dBs = normal hearing (this refers to the amount of volume raised in order to hear the sound)
21-39dB is abnormal (mild hearing loss)
>40dB is abnormal (moderate hearing loss)
what is BPPV?dx? txt?
benign paroxysmal (comes and goes) positional vertigo Dx: positional change = nausea txt: antiemetics, otolith repositioning, habituation
what is vertigo?
brain is getting mixed signals from inside the semicircular canals (rocks moving around and bending cilia- they get stuck and continuously stimulate cilia cells)
what is the dix-hallpike maneuver?
to localize labryinthe dysfunction
-positive test w/ affected ear down = nystagmus (lateral eye twitch) towards affected ear
what is the epley maneuver?
to fix vertigo - reposition otoliths
* you can also habituate vertigo by performing movements that produce symptoms over and over
what is the pathophys cause of meniere’s disease?
inner ear disorder aka idiopathic endolymphatic hydrops (extra endolymph fluid in cochlea)= pressure=vertigo
what is the triad of symptoms with meniere’s disease? what about w/ back attacks?
- hearing loss
- tinnnitus
- vertigo
* fall-down with bad attacks, difficulty walking
Ddx for meniere’s should include what disease that is commonly included in many Ddx?
syphilis
txt for meniere’s ?
send to ENT
-meclizine for nausea
-scolpolamine patch behind ear
diuretics and low sodium diet (reduce fluid)
endolymph shunt (surgical- drain in cochlea)
what is vestibular neuronitis?
suddent onset of vertigo related to neural afferents W/OUT inflamm.
- possible HSV cause (in vestibular ganglia)
- may have hearing loss
what is labyrinthitis?
inflamm disorder of inner ear or labyrinth
- URI preceding- but can be bacterial or viral
- ALWAYS has hearing loss but does NOT recur (unlike Vest. N)
BEST predictor of AOM?
TM with impaired mobility
