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Pediatrics > Ear and Hearing Disorders > Flashcards

Ear and Hearing Disorders Flashcards

1
Q

Appointments for hearing screening

A
  • Newborns (by 1 month of age)
  • F/U of abnormal NB screen by 3 months
  • Puretone audiometry at 3, 4, 5, 6, 8, 10, 12, 15, and 18 years
    ** More frequent for children at risk
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2
Q

Medical History Assessment of Ears

A
  • hx of ear conditions
  • hx or family history of ear abnormalities or kidney abnormalities
  • itching/discharge
  • prematurity
  • URI
  • tinnitus
  • exposure to daycare, smoke, noise
  • DM
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3
Q

Physical Examination Assessment of Ears

A
  • inspection of external ear structures
  • developmental milestones of hearing/speech
  • palpation/rotation for tenderness/inflammation
  • otoscopic examination
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4
Q

Pressure Equalizing Tubes

A
  • refer if recurrent AOM 3 times/6 months or 4 times/year
  • craniofacial abnormalities may warrant PET
  • PET placement under general anesthesia
  • No precautions if bathing, showering, or surface swimming
  • Earplugs if driving or dunking
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5
Q

Otitis Externa Causes

A
  • protective barriers in EAC damaged
  • P. aeruginosa, S. aureus most common
  • otomycosis caused by Aspergillus or Candida
  • chlorine kills normal ear flora
  • regular cleaning removes the cerumen barrier
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6
Q

Clinical Findings of Otitis Externa

A
  • itching and irritation
  • pain disproportionate to what is seen on exam
  • pressure/fullness in ear
  • hearing loss may occur
  • sagging of superior canal, periauricular edema; pre- and postauricular lymphadenopathy
  • swollen EAC with debris
  • rare otorrhea
  • red, crusty, or pustular lesions
  • presence of PET or perforation of TM
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7
Q

Diagnostic Studies for Otitis Externa

A

Not necessary to culture unless improvement not seen with treatment

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8
Q

Management of Otitis Externa

A
  • eardrops are mainstay (acetic acid or antibiotic with or without corticosteroid drops)
  • no ototoxic drops if risk of perforation
  • systemic antibiotics not used unless severe
  • pt education about drops
  • use a wick if significant swelling
  • avoid cleaning, manipulating, getting warmer into ear = no swimming
  • analgesics for pain
  • debridement with cotton-tipped applicator
  • clena canal with water or antiseptic solution if impetigo and apply antibiotic ointment
  • treat fungal infections with clotrimazole-miconazole, or nystatin
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9
Q

Complications of Otitis Externa

A
  • infection of surrounding tissues with impetigo
  • irritated furunculosis
  • malignant OE with progression/necrosis
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10
Q

Prevention of Otitis Externa

A
  • avoid water in ear canals
  • well fitting earplugs for swimming
  • alcohol/vinegar/distilled water otic mix (2:1:1); 3-5 drops daily, especially after swimming
  • blow dryer on warm setting to dry EAC
  • avoid persistent scratching/cleaning of EAC
  • avoid prolonged use of cerumenolytic agents
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11
Q

Clinical Findings of Foreign Body in Ear Canal

A
  • report of something in the ear
  • itching, buzzing, fullness
  • persistent cough or hiccups
  • unilateral otalgia/otorrhea
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12
Q

Management of Foreign Body in the Ear Canal

A
  • adequate visualization
  • refer to ENT if first attempt unsuccessful
  • disk batteries must be removed emergently!!
  • spherical objects most difficult
  • suffocate insects with mineral oil and refer
  • irrigate only if TM is intact
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13
Q

Complications of Foreign Body in the Ear Canal

A
  • infection
  • perforation of TM
  • damage to ossicles
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14
Q

3 Components to Diagnose Otitis Media

A
  1. recent, abrupt onset of middle ear inflammation and effusion
  2. MEE confirmed by bulging TM, limited/absent mobility by pneumatic otoscopy, air-filled level behind TM, otorrhea
  3. signs/symptoms of inflammation - distinct erythema of TM, pain
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15
Q

Common Causes of Eustachian Tube Dysfunction

A
  • URI
  • allergies
  • environmental tobacco smoke
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16
Q

Causes of Acute Otitis Media

A
  • ETD
  • S. pneumoniae
  • nontypeable H. infuenzae
  • M. catarrhalis
  • S. pyogenes
  • viruses usually initial causative factor, but most AOM caused by bacteria or combination bacteria/virus
17
Q

Clinical Findings of AOM

A
  • rapid onset of symptoms
  • ear pain/pulling in infant
  • irritability in infant/toddler
  • otorrhea
  • fever
  • bulging TM
  • decreased translucency of TM
  • absent or decreased mobility of TM
  • air fluid level behind TM
  • erythema
  • red, yellow, purple TM
  • thin walled, sagging bullae filled with straw-colored fluid (bullous ,myringitis)
18
Q

Management of AOM

A
  • amoxicillin BID (first line if no AOM in past 30 days, no conjunctivitis, no PCN allergy)
  • bata lactam coverage if treated in the last 30 days
  • ceftriaxone for vomiting child
  • clindamycin for ceftriaxone failure; only if susceptibilities known
  • no prophylactic antibiotics
  • “watchful waiting”
19
Q

Watchful Waiting of AOM

A
  • pain relief should be provided
  • parent initiated visit/phone call for worsening
  • scheduled F/U appt.
  • Routine F/U phone call
  • prescription to start if no improvement or worsening in 48-72 hours
  • communication with parent, re-evaluation, ability to obtain medication must be in place
20
Q

Management of Persistent/Recurrent AOM

A
  • if abx therapy complete with evidence of AOM still present, or recurrence within days - broad spectrum abx recommended
  • persistent middle ear effusion common; abx not necessary
  • recurrent AOM if > 3/6 months or > 4/year
  • otolaryngology referral when therapy fails
21
Q

Prevention and Education for AOM

A
  • pneumococcal vaccine
  • flu vaccine
  • xylitol gum/liquid if > 2 years
  • exclusive breastfeeding to 6 months
  • licensed daycare/fewer children
  • avoid bottle propping, smoke exposure
  • avoid use of pacifiers
  • educate about drug resistant bacteria, antibiotic use
22
Q

Clinical Findings of Otitis Media with Effusion

A
  • often asymptomatic/afebrile
  • intermittent mild ear pain
  • fullness in ear
  • hearing loss in older children
  • dizziness or impaired balance
  • chronic vomiting, failure to thrive
  • decreased TM mobility
  • TM dull, bulging, opaque
23
Q

Prevention and Education for Otitis Media with Effusion

A
  • F/U until TM/hearing normal
  • remember important role of language development
  • Maximize hearing by:
    1. facing child; get within 3 ft
    2. enunciating clearly
    3. using visual clues
    4. turning off competing background noise
    5. requesting preferential classroom seating
24
Q

Clinical Findings of Perforated TM

A
  • may have no symptoms; may hear whistling sounds with sneezing, hearing loss
  • profuse otorrhea may obscure TM
25
Q

Management of Perforated TM

A
  • control otorrhea/watchful waiting while healing
  • avoid ototoxic eardrops/treat with otic drops for ear infection if present
  • no swimming
  • most perforations will heal within 3 months

Pediatrics (12 decks)

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