Ear

Question 1

Otitis Externa

Answer 1

Infection/inflammation of external auditory canal, auricle, or both
Usually from swimming or trauma
Symptoms – ear pain, hearing loss, pressure, redness, ringing, itching, discharge
Findings – pain on palpation of the tragus, swelling, redness, & narrowing of ear canal, discharge
Treatment – topical ABX, if severe may need an ear wick, pain control
Cortisporin 4 drops in ear QID x 7 days, Ciprodex 4 drops in ear BID x 7 days
Education – keep dry, avoid q-tips
Refer if severe or refractory

Question 2

Otitis Media

Answer 2

Middle ear infection/inflammation
Symptoms – ear pain, headache, fever, irritability, vomiting/diarrhea, hearing loss, tinnitus, vertigo
Pneumatic otoscopy is standard exam technique for AOM – finding is decreased mobility
Evaluate for color, position, mobility, and perforation
Most commons pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella, RSV, Influenza, Rhinovirus, Adenovirus
Breastfeeding is protective
Risk factors – smoke exposure, daycare attendance, socioeconomic factors

Question 3

Otitis Media in Adults

Answer 3

Otalgia (pain in the inner ear)
Ear drainage
Diminished hearing
Sore throat
Opacity and redness of the tympanic membrane are equally common in children and adults.
Guidelines for antibiotic use are the same in children and adults.
Smoking should be discouraged.
Nasal and oral steroids may be beneficial in patients with persistent acute otitis media and associated allergies.
Adults with unilateral middle ear effusion lasting longer than two months should undergo imaging studies to rule out intracranial neoplasm, especially if the effusion is associated with cranial nerve palsy

Question 4

Otitis Media Antibiotics for Adults

Answer 4

First Line
Amoxil 80-90mg/kg BID
Pen Allergy -Macrolide (mycins)
Cefuroxime 30mg mg/kg/d BID
Cephalosporin-remember  only 2-10% of persons with pen allergy will be allergic to cephalosporins
Persistent Symptoms no improvement after 48-72 hours
Amox/clavulanate
Ceftriaxone 50mg/kg IM IV daily x 3 days
Clindamycin 30-40mg/kg/d TID

Question 5

Eustachian Tube Dysfunction

Answer 5

Symptoms – ear fullness, muffled sounds, popping, ear pain, ringing, balance issues
Treatment – swallowing, chewing gum, yawning, decongestants, antihistamines, steroid nasal spray
Very common in children, smokers, and those with URI

Question 6

Perforated Tympanic Membrane

Answer 6

From infection or trauma
Symptoms – pain, drainage, decreased hearing
Usually does not require repair and will heal on own
Treatment – avoid drops, water in ear x 6 weeks, recheck in 6 weeks for healing
Oral ABX – usually Amoxicillin to prevent secondary infection

Question 7

Conductive Hearing Loss

Answer 7

Sound cannot get into middle ear
Weber- hear the tuning fork loudest in the affected ear
Impacted cerumen
Otitis externa
Otitis media with effusion

Question 8

Sensorineural hearing loss

Answer 8

Presbycusis-Loss of high frequency sounds
Trauma
Meniere’s disease
Acoustic tumors
Noise exposure

Question 9

Impacted Cerumen

Answer 9

Can cause pain, decreased hearing, and dizziness
Avoid use of ear candle
Removal using Debrox at home, flushing, use of curette
Use care in removal
Prevention is key – avoid q-tips, regular ear care