Ear Flashcards
Types of hearing loss
conductive (AOM) & sensorineural (inner ear)
acute otitis media (AOM)
presence of inflammatory fluid in the middle-ear space
acute onset of local findings
erythematous and/or bulging tympanic membrane tympanic membrane that is not mobile on insufflation.
Otitis Media with Effusion (OME)
Otitis media with effusion (OME)
AKA serous otitis media
inflammatory fluid in the middle-ear space
asymptomatic child
child with mild upper respiratory tract symptoms.
Recurrent otitis media
≥3 episodes of AOM in 6 months
4 episodes in 1 year
Chronic otitis media
OME that lasts > 3 months
OME that is a suppurative middle-ear process that fails to respond to initial antibiotic therapy
otitis externa
inflammatory process that involves structures of the outer ear, specifically the external auditory canal.
Most frequent OM pathogens
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
H. influenzae was isolated more often in children with bilateral than unilateral AOM
Speculum length
The largest speculum that will fit into the external auditory canal at a depth of ⅓ inch to ½ inch should be attached to pneumatic otoscope.
Permits visualization of the largest possible area and ensures a relatively airtight seal for insufflation
Dx is confirmed with pneumatic otoscopy
antibiotic recs under 2 years
Children <6 months with AOM be treated immediately with an appropriate antibiotic.
Children 6 - 24 months with bilateral AOM be treated immediately with an appropriate antibiotic.
Suggest immediate treatment for children 6 – 12 months with unilateral AOM.
Children 6 – 24 months with unilateral AOM and mild symptoms initial observation after joint decision-making with the parent
Given the high rate of treatment failure among children <24 months with unilateral non-severe AOM it is suggested to treat these children with antimicrobial therapy.
Over >2 years old recs
Children ≥2 years who appear toxic, have persistent otalgia for more than 48 hours, have temperature ≥102.2°F (39°C) in the past 48 hours, have bilateral AOM or otorrhea, or have uncertain access to follow-up be immediately treated with an appropriate antibiotic.
observation is appropriate when
Observation of a patient without antibiotic therapy for 48–72 hours is now considered an acceptable management option in low-risk patients > 6 months of age.
First line antibiotic
High-dose amoxicillin is the recommended first-line choice.
Treatment should be administered for 10 days.
Shorter courses of 5–7 days may be acceptable in low-risk patients (older children with uncomplicated histories).
second line antibiotic therapy
If fever, ear pain, and objective findings of AOM persist despite ≥ 72 hours of therapy, then a change of antibiotic may be warranted.
Second-line agents, such as second- or third-generation cephalosporins or amoxicillin plus clavulanate
For patients who develop hives or anaphylaxis to β-lactam antibiotics, azithromycin may be used.
recurrent OM- tympanostomy tubes
≥ 3 episodes of AOM within 6 months or of 4 episodes within 1 year satisfies many experts’ definition of recurrent otitis media.
When recurrent AOM complicates OME plus hearing loss.
Frequent episodes of AOM (without OME) that respond to appropriate antibiotic therapy are not an indication.
follow up OM
50% of middle-ear effusions resolve by 6 weeks after initial presentation.
Follow-up for an otherwise healthy and asymptomatic child should be scheduled no sooner than 6 weeks post diagnosis, if at all.
mastoiditis symptoms
Mastoiditis is an infection of the mastoid bone of the skull.
Drainage from the ear Ear pain or discomfort Fever, may be high or suddenly increase Headache Hearing loss Redness of the ear or behind the ear Swelling behind ear, may cause ear to stick out
otitis externa causes
Trauma to the external auditory canal Presence of a foreign body Repeated ear cleansing Prolonged exposure to standing water in the ear canal Swimming or bathing (swimmer’s ear) High environmental temperature and humidity Increased sweating Allergy Stress
OE bacteria
When inflammation is focal and associated with infection, the organism is often S aureus.
Can lead to furuncle formation at the site of the inflammation
The most common organism associated with diffuse inflammation is Pseudomonas aeruginosa.
OE treatment
Diffuse OE usually responds to 4 times-a-day application of a topical otic solution containing:
Neomycin
Polymyxin B
Hydrocortisone
I&D may be necessary with furuncle (boil)
nasal foreign body differential dx
Suppurative rhinitis
Adenoiditis
Sinusitis
Nasal or nasopharyngeal tumors
Nasal polyps also may cause unilateral nasal discharge.
In a young child, cystic fibrosis must be ruled out.
foreign body referrals
If airway compromise exists
Anytime a battery is involved
If the child cannot be restrained adequately
If an object cannot be removed
Ear
If the tympanic membrane cannot be visualized or perforation is suspected
If the object is touching the tympanic membrane
If the object is spherical or in the canal for >24 hours
If hearing loss, nystagmus, vertigo, central nervous system deficits, or deep-seated infection exists
Nose
If a rhinolith has formed
Airway
For tracheal and bronchial foreign bodies
Esophagus
For endoscopic removal if perforation is suspected
