Ear Flashcards
Occurs when increased amounts of hard
cerumen partially or completely occludes the
ear canal
• Symptoms: decreased hearing, sensation of
pressure in ear canal
Cerumen Impaction
How to tx Cerumen Impaction?
Use a commercial wax softener (or baby/mineral oil) first. Then use a cerumen spoon and or a Water Pik or warm saline irrigation with a bulb syringe.
how to prevent cerumen impaction?
Prevention: Do not use Q-tips. Use soft cloths and soap to clean auricle; may use OTC ear wax drops.
Symptoms: pain within the ear canal, pressure, or decreased hearing
Ear foreign body
Skin infection of the external auditory canal- Pain with pressing on tragus
Otitis Externa
Symptoms: pain of the ear and auricle which
occurs within a two-day time period in the last
three weeks; fullness or pruritus within the ear;
in some cases purulent exudate within the canal
Otitis Externa
How to manage Otitis Externa if RM Intact ?
how to prevent
NSAIDS, if ™ intact, ear lavage, Ofloxacin/ Ciproflaxacin/ Dexamethasone
Prevenion: ear plugs with swimming, no scratching, hair dryer to ear,
What should be used if the TM is not intact or its status cannot be determined visually?
Ofloxacin or ciprofloxacin/ dexamethasone (Ciprodex)
Otic drops are approved for middle ear use
Indications for removing ear foreign body?
visible FB in external canal, proper equipment to assist with extraction, and a cooperative patient
an acute infection of the middle ear • Common pathogens: • S. pneumoniae • Haemophilus influenzae (non-typeable) • M. catarrhalis
Acute Otitis Media
- Abrupt onset of symptoms: otalgia, irritability, otorrhea
- Middle ear effusion confirmed by bulging TM, limited or decreased mobility, air-fluid level
- Presentation of middle ear inflammation: erythematous TM, otalgia, symptoms interfere with activities
Acute Otitis Media
How to Manage of AOM
Watchful waiting for 48-72 hours
Pain management (Tylenol or NSAIDS)
• Antibacterial therapy
• ENT referral if indicated
** Based on patient age and symptoms
AAP recommendation for AOM Tx for 6 months to 2 years
Unilateral or bilateral with severe symptoms or Bilateral without Otorrhea
Amoxicillin 80–90 mg/kg/day divided bid 5–7 days
Amoxicillin/clavulanate 90 mg/kg/day divided bid: 10 days
AAP recommendation for AOM Tx for ≥2 years
Unilateral or bilateral with severe symptoms or Bilateral without Otorrhea
Amoxicillin 80–90 mg/kg/day divided bid
Amoxicillin/clavulanate 90 mg/kg/day divided bid
How to prevent AOM?
•Pneumococcal conjugate vaccine
• Influenza vaccine
• Breastfeeding: clinicians should encourage exclusive breastfeeding for at least six months
• Avoidance of tobacco smoke exposure
- avoid bottle propping and use of pacifiers after 6 months of age
AAP tx recommendation for 6mo -2 years with Unilateral AOM without Otorrhea
Antibiotic therapy or
additional observation
AAP tx recommendation for ≥2 years with Unilateral or bilateral AOM without
Otorrhea
Antibiotic therapy or
additional observation
What med can you use to tx AOM for pts with penicillin allergy?
Cefdinir
What is considered to be recurrent AOM?
3 or more infections within a 6 month period or 4 or more infections in 12 months… with one episode occurring within the last 6 months
Causes of TM perforation?
child who has had AOM- most common
Blast injury or Barotrauma
cholesteatoma (rare)
Tx plan for TM perforation?
Check hearing!!
Avoid ototoxic drugs
Keep ear dry (wear earplugs when in h2o)
… dont use standard drops because they can get into middle ear and be dangerous- only use suspension format drops
When to refer TM perforation ?
refer of perforation is not healing… typically takes 3-4 weeks after infection, longer for trauma
refer pts that already have hearing problems
How does a ruptured TM from Blast injury or Barotrauma present?
persistent pain and hearing loss
How does a ruptured TM from child with AOM?
pain’s going to be gone as soon as the rupture happens
Serous fluid in middle ear with no S/S infection or inflammation
Might present before or after an ear infection but can occur spontaneously
More common in children and those with a cleft palate or Down syndrome
Otitis Media With Effusion (OME)
Causes of Otitis Media With Effusion (OME)?
Caused by a build-up of fluid in the middle ear, usually due to Eustachian tube dysfunction (swelling)
•Can result from acute otitis media (AOM), viral infection, allergies, anatomical abnormalities
•Can be chronic (known as serousotitis media)
Common presentation of Otitis Media With Effusion (OME)?
Patient might complain of muffled sounds, “talking in a drum,” popping noises
Sometimes patient will complain of otalgia (ear pain)
Afebrile
Might complain of hearing loss
Physical exam findings with Otitis Media With Effusion (OME)?
TM may be full or retracted
Decreased TM mobility
•TM often described as “dull”, may see bubbles posteriorly
Should not be bulging or red
common differentials with Otitis Media With Effusion (OME)?
Acute otitis media
Chronic otitis media
Otitis externa
Foreign body in the ear canal
How to tx Otitis Media With Effusion (OME)?
Symptomatic (analgesics—if needed, antihistamine—if allergic component)
•Do NOT use antibiotics
•not recommend oral or intranasal steroids, decongestants, or antihistamines to treat
•Avoid secondhand smoke; avoid pacifiers during the day if over 12 months old
•Monitor for any hearing loss and/or developmental delays- > ENT
prognosis for Otitis Media With Effusion (OME)? how long to typically heal?
Majority will resolve on their own over three months
May need ENT referral for possible tube placement
Bacterial infection of the mastoid cells •Results from unresolved OM •Presents with fever, irritability, lethargy •Swelling around the ear •Redness and tenderness behind the ear- POSTAURICULAR SWELLING •Drainage from the ear •Bulging and drooping of the ear •6–13 months
Mastoiditis
H&P for Mastoiditis
- Recent OM?
- Treatment for OM?
- All medication taken?
- Fever, malaise, tenderness?
- Dental care?
- N/V/D?
- Vision changes?
- VS
- Inspection of area
- HEENT Exam
- Cardiac and lung
Diagnostics and Treatment for Mastoiditis
URGENT ENT referral → hospitalization with IV ABX (cephalosporins and dexamethasone) and surgical intervention required (I&D and culture)
Send for CT scan
blunt trauma causes tears in blood vessels leading to hematoma. Hematoma stimulates cartilage formation resulting in deformity.
Auricular tenderness and swelling, Blood on outside of ear, Erythema or ecchymosis to overlying skin
Refer to otolaryngology within 7 days of trauma to prevent cartilage growth
Auricular Hematoma: “wrestler’s ear” or cauliflower ear
inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after ABX tx
Tympanostomy Tubes
1st line choice of abx tx for AOM
Amoxicillin 80-90mg/kg/day BID
Good when a child has both AOM + conjunctivitis, was treated with amox in the last 30 days or is allergic to penicillins. This medication is more costly and can cause more diarrhea.
Amoxicillin/Clavulanate (Augmentin) 80-90mg/kg/day BID
Choice of abx tx for PCN allergy for AOM
Cefdinir
Recommended if there is tympanic membrane perforation (as they are not ototoxic), draining pressure equalizer (PE) tubes or there is otorrhea.
-Ototopical antibiotics drops:
1-Ofloxacin
2- Ciprofloxacin/ Dexamethasone (Ciprodex)
Recommended if there is tympanic membrane perforation (as they are not ototoxic), draining pressure equalizer (PE) tubes or there is otorrhea.
-Ophthalmic antibiotic drops:
1-Tobramycin
2-Gentamicin
2 week hx of severe itching and tearing of both eyes. redness. swelling of eyelids, along with stringy, mucoid discharge.
What to prescribe?
Topical NSAID Drops
Conjunctivitis
Child with PET tubes in both ears with mild otalgia in one ear- able to visualize the tube and no exudate in ear canal - type A tympanogram obtained
Order ototopical antibiotic/ corticosteroid drops
resembles a teepee and shows a normal middle ear system that has no fluid and an intact tympanic membrane. It also indicates the absence of any kind of physiological anomalies that usually prevent the entrance of sound into the cochlea from the middle ear.
type A tympanogram
