Ear

Question 1

Types of hearing loss

Answer 1

conductive (AOM) & sensorineural (inner ear)

Question 2

acute otitis media (AOM)

Answer 2

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.

Question 3

Otitis Media with Effusion (OME)

Answer 3

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.

Question 4

Recurrent otitis media

Answer 4

≥3 episodes of AOM in 6 months

4 episodes in 1 year

Question 5

Chronic otitis media

Answer 5

OME that lasts > 3 months

OME that is a suppurative middle-ear process that fails to respond to initial antibiotic therapy

Question 6

otitis externa

Answer 6

inflammatory process that involves structures of the outer ear, specifically the external auditory canal.

Question 7

Most frequent OM pathogens

Answer 7

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

H. influenzae was isolated more often in children with bilateral than unilateral AOM

Question 8

Speculum length

Answer 8

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

Question 9

antibiotic recs under 2 years

Answer 9

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.

Question 10

Over >2 years old recs

Answer 10

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.

Question 11

observation is appropriate when

Answer 11

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.

Question 12

First line antibiotic

Answer 12

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).

Question 13

second line antibiotic therapy

Answer 13

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.

Question 14

recurrent OM- tympanostomy tubes

Answer 14

≥ 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.

Question 15

follow up OM

Answer 15

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.

Question 16

mastoiditis symptoms

Answer 16

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

Question 17

otitis externa causes

Answer 17

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

Question 18

OE bacteria

Answer 18

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.

Question 19

OE treatment

Answer 19

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)

Question 20

nasal foreign body differential dx

Answer 20

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.

Question 21

foreign body referrals

Answer 21

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