Ear and sinus infections Flashcards
Otitis externa
Characterized by :
General ________ and ________, with associated _______, with or without ______
Oedema
Erythema
Itchy discomfort
Eat discharge
Otitis externa
Causative agents :
List 3
Pseudomonas species
Staphylococci
Streptococci/Gram negative rods
Fungi( Aspergillus/candida species)
Treatment for Otitis externa:
Most common pathogens are :_____,______,_______, and ———
Treatment :
_______
________
__________
___________
Pseudomonas , staph, E.coli, and proteus
Ear toilet
Antibiotics
Medicated wicks
Analgesics
Treatment for Otitis externa:
Avoid _______ or ________ or ________
Water entry
Cotton buds
Digital manipulation of ear canal
Fungal Otitis Externa
(Otomycosis)
• Aspergilus niger -I- ______ headed filamented growth
• Aspergilus fumigatus- _______
• Candida albicans- ______/______ deposits
• Secondary fungal infection may be seen in patients using ___________ for otitis externa/ middle ear suppuration
black ; brown
white/creamy
topical antibioties
Fungal Otitis Externa
(Otomycosis)
• _____________ -I- black headed filamented growth
• ________________- brown
• ________________- white/creamy deposits
Aspergilus niger -I-
Aspergilus fumigatus
Candida albicans
OTITIS MEDIA
Definition: Presence of a ___________
middle ear infection
OTITIS MEDIA
Acute Otitis Media: occurrence of ________ infection within the ___________
Otitis Media with Effusion: presence of __________ within the ___________
bacterial infection ; middle ear cavity.
nonpurulent fluid ; middle ear cavity
OTITIS MEDIA
OM is the _______ most common clinical problem in childhood after _____________________
second
upper respiratory infection.
RISK FACTORS for OM
_________________ Infections
_________
_________ abnormalities (_________) _________ Syndrome
_________ smoking
(Boys or Girls?) > (boys or girls?)
Daycare
Upper Respiratory
Allergies
Craniofacial ;cleft palate
Down’s ; Passive
Boys > girls
SIGNS & SYMPTOMS of otitis media
Neonates/Infants: change in _______,
irritability, ______ at ears, decreased _______, vomiting.
Children(2-4): ______, fever, _____ in ears,
cannot _____ properly, changes in _______
Children (>4): complain of _______, changes In _________-
behavior ; tugging ; appetite
otalgia ; noises ; hear ; personality
ear pain ; personality
EPIDEMIOLOGY of otitis media
Peak incidence in the _____ years of life (esp. _____months)
(Boys or Girls?) more affected than (boys or girls?)
50% of children under ___ yr of age will have at least 1 episode.
1/3 of children will have 3 or more infections by age _____
90% of children will have at least one infection by age ____.
50,000 deaths / year worldwide
first two ; 6-12 months
Boys ; girls
1 ; 3 ; 6
causative agents of otitis media
_____________ —————-
_____________ —————-(non-typeable)
_____________ —————-
Group ___ Streptococcus
_____________ —————-
_____________ —————-
____ associated with _____________
Streptococcus pneumoniae Haemophilus influenzae(non-typeable) Moraxella catarrhalis
Group A Streptococcus
Staph aureus
Pseudomonas aeruginosa
RSV assoc. with Acute Otitis Media
Most common cause of Acute otitis media is???
Most uncommon cause of AOM
Streptococcus pneumoniae
Pseudomonas aeruginosa
Treatment Considerations for otitis media
________________ (DRSP) incidence is increasing
Patients at high risk for DRSP
– Attending _______
– <___ years old
– Antibiotic therapy in _________
Drug resistant S. pneumoniae
day care
2; preceding 3 months
Number Need to Treat (NNT) NNT for antibiotic therapy in AOM
________ children with AOM would have to be treated with antibiotics to prevent one case of clinical failure by 1 week.
One review estimated the need to treat ________ in order for 1 child to have improved pain at 2 days.
In addition, ______ were associated with almost twice the rate of vomiting, diarrhea, and rashes.
7 to 8
17 children
antibiotics
Definitions
Non-severe illness is :______ otalgia and fever ____°C in the past 24 hours
Severe illness is __________ otalgia OR fever _____°C
Mild; <39
Moderate to severe
> or equal to 39
certain diagnosis of AOM meets all 3 criteria …
1)______ onset
2) Signs of _____
3) Signs and symptoms of ____________
Rapid
MEE
middle-ear inflammation.
Otitis media
Observation is only appropriate when …
_______ can be ensured and ______ therapy initiated if symptoms persist or worsen
Follow-up
antibiotic
Why Focus on Pneumococcus?
Most common _________ pathogen
Most common isolate after ______
Least likely bacterial pathogen to _______
Most likely to cause _____ otitis media
Most likely to cause _______ complications of otitis ( __________ )
initial bacterial
failed therapy
self resolve; severe
suppurative
mastoiditis
In allergy to Amoxicilin
Alternative therapy in the penicillin-allergic patient who is being treated for infection that is known or presumed to be caused by penicillin-resistant S pneumoniae is _________ at 30 to 40 mg/kg per day in ___ divided doses.
In the patient who is vomiting or cannot otherwise tolerate oral medication, a _____ dose of _______ __________ (50 mg/kg) has been shown to be effective for the initial treatment of AOM.
clindamycin; 3
single; parenteral ceftriaxone
Duration of therapy for otitis media
For children ≥ 6 years of age with mild to moderate disease _______ days is appropriate
For younger children and for children with severe disease, a standard ____-day course is recommended
5 -7
10
Treatment Failure
No improvement in ear pain, fever, or tympanic membrane otorrhea, bulging or redness after ______ of antibiotic therapy
2nd Line Therapy
–_______
– ___________ producing _________ and __________
3 days
DRSP
Beta-lactamase
H.influenza and M. cattarhalis
Prevention of Otitis Media
_____________ pneumococcal conjugate vaccine (n=37,868)
Reduction of ______________
Reduction of _________ prescriptions
Influenza vaccine: Goal: decrease number of URI
______________
Heptavalent
otitis office visits; antibiotic
Breast feeding
