Ear Disease

Question 1

Pre-auricular pit:

typical findings and Tx

Answer 1

result of embryologic anomaly

if infected: Abx, warm soak

excision (with tissue behind the superior pinna) if repeatedly become infected

Question 2

Auricular hematoma: typical findings and Tx

Answer 2

occurs with trauma to the pinna (between cartilage and perichondrium)

Tx: Abx, posterior ear block, drain→ apply pressure dressing

If don’t treat cartilage dies and calcifies→ “cauliflower ear”

Question 3

Perichondritis:

typical findings and Tx

Answer 3

cartilage has no intrinsic blood supply, so if separated from perichondrium, cartilage has no drainage

visible redness on top portion of pinna (can see where the infection stops→same place cartilage ends)

Tx: Abx with good cartilage penetration (IV or wick)

Question 4

Disorders of the auditory ear canal: Otitis externa

typical findings and Tx

Answer 4

otitis externa= draining ear

(redness, irritation, pain of external ear canal)

Bacterial→ Pseudomonas

Fungal

Tx: if draining→topical drops (even if tubes or perforation)

**careful if perforation, drops potentially ototoxic

Question 5

Disorders of the auditory ear canal: Granulomas

typical findings and Tx

Answer 5

highly vascular mass of fibrous tissue and blood vessels which the body forms in response to a chronic infection

(often in kids with ear tubes)

granulation tissue= salmon colored

Tx: steroid-containing Abx ear drops (surgical excision if persistent disease)

Question 6

Disorders of the auditory ear canal: Exostosis

typical findings and Tx

Answer 6

BENIGN, bony growth(s)

cold water exposure, surfer’s/kayaker’s ear

Tx: only if trapping wax and causing hearing problems (then refer to ENT)

Question 7

Disorders of the auditory ear canal: Osteoma

typical findings and Tx

Answer 7

Reddish benign bony TUMOR

causes problems bc grows to touch TM or ocludes canal (which impedes epithelial migration)

always refer to ENT

Question 8

Disorders of the TM/middle ear: Tympanosclerosis

clinical findings

Answer 8

tympanosclerosis= scar plaque

NOT pathological

BRIGHT white, calcified mass between TM layers

can cover small region or almost entire ear drum, but always surrounded by NORMAL appearing TM

MOVES with pneumatoscopy

Question 9

Disorders of the TM/middle ear: TM perforations

clinical findings, Tx, potential complications

Answer 9

shiny, middle ear mucosa visible through perforation⇒ be able to draw quadrant location and give percentage

50% of time heals spontaneously

Tx: refer immediately if: vertigo or infection

refer to ENT if doesn’t heal on own in 2 weeks

if draining→ drops

Keep dry with vaseline and cotton swab when showering

Question 10

Disorders of the TM/middle ear: TM retractions

clinical findings, Tx, potential complications

Answer 10

Eustachian tube dysfunction. NOT benign→ when TM retracts, it can put pressure on the ossicles leading to bony erosion and conductive hearing loss (refer if either)

Tx: antihistamines, salt water nasal flushes, ear tubes

Question 11

Disorders of the TM/middle ear: Cholesteatoma

clinical findings, Tx, potential complications

Answer 11

Inflammation is present. Trapped epithelium cannot properly migrate out of ear canal (trapped in deep retraction pockets = 1º cholesteatoma)

Drainage from infected debris

Continues to enlarge and acts like a tumor. Pressure and enzymes cause erosion of bone (ossicles, bone to mastoid, semicircular canals, facial nerve, brain)

Tx: SURGERY, refer if this is even a possibility

Question 12

clinical presentation of mastoiditis

Answer 12

serious complication of otitis media→ swelling at mastoid process

pushed ear out and down

MEDICAL EMERGENCY even if child feels fine

Question 13

when to refer to ENT for ear disorders

Answer 13

if vertigo with TM perforation

if TM perforation not healed after 2 weeks

if TM retraction causes bony erosion/conductive hearing loss (eustachian tube dsyfxn)

if find/suspect cholesteatoma

for mastoiditis (even if child feels well)

Question 14

management for children with suspected hearing loss

Answer 14

screening: otoacoustic emissions (OAE) testing or auditory brainstem evoked responses (ABR)

Everyone tested by 3mo, if fail OAE→test by ABR for more definitive evaluation

also test if parents suspect problem and if known risk factors

**many children develop hearing loss AFTER neonatal period, so don’t assume neonatal screening catches all

Question 15

Hearing milestones (0-24mo)

Answer 15

0-4mo→ startle to loud noise and calm with parent’s voice

6mo→ turn head to sound, imitate cooing

1yr→ respond to name

13-15mo→ point to people/objects when asked

18mo→ follows verbal instructions without gesticulations

2yr→ point to body parts when asked

Question 16

referral guidelines for children with “speech delay”

Answer 16

12mo→ no differentiated babbling or vocal imitation

18mo→ no use of single words

24mo→ single-word vocab of <10words

30mo→ <100 words, no 2-word combos, unintelligible