Ear Disorders Flashcards
A child with a preauricular pit is at increased risk for what kind of impairment?
Hearing impairment
Describe the relationship between preauricular sinus/pit and renal abnormalities.
There is no association between isolated preauricular sinus/pit and renal abnormalities. However, if the infant has other associated congenital abnormalities or hearing loss, a renal ultrasound should be performed to rule out associated syndromes.
What are the most common pathogens in otitis externa?
Pseudomonas aeruginosa and S. aureus
What physical exam finding can be used to distinguish otitis externa from otitis media?
Worsening pain with manipulation of the pinna is concerning for otitis externa, as it is not present in patients with otitis media.
What is the typical treatment for otitis externa?
Treatment consists of a topical antibiotic and glucocorticoid. Fluoroquinolones (ofloxacin and ciprofloxacin) are preferred, but aminoglycosides and polymyxin B may be used as well. Treat for 7-14 days. Fluoroquinolones are administered 2x/day, while the other antibiotics must be given 3-4x/day.
What is the typical management of foreign bodies in the ear?
Removal techniques include irrigation and instrumentation under direct visualization. Mineral oil or lidocaine can be placed in the ear canal to kill live insects prior to removal.
When should patients with foreign bodies of the ear be referred to ENT?
If proper instruments for removal are not available or if removal is difficult.
What is the recommended management of auricular hematoma?
Drain as soon as possible to prevent necrosis and cauliflower ear. Refer to ENT if drainage is delayed >7 days.
What is an auricular hematoma?
It is an accumulation of blood between the cartilage and the perichondrium that interrupts the blood supply to the cartilage.
What are the most common bacterial pathogens of acute otitis media?
S. pneumoniae, nontypeable H. influenzae, and Moraxella catarrhalis.
What are some (5) risk factors for development of otitis media?
Age (6-18 months), family history, day care attendance, lack of breastfeeding, and tobacco smoke exposure.
What physical exam findings are required for diagnosis of acute otitis media?
Bulging tympanic membrane, middle ear effusion, and opaque tympanic membrane.
What is the recommended antibiotic regimen for patients diagnosed with acute otitis media?
High dose (90 mg/kg/day) amoxicillin, with recommendation to broaden to amoxicillin/clavulanate or 2nd/3rd generation cephalosporin if patients fail to respond within 48 hours.
What is the recommended initial management of children 6 months - 2 years of age with unilateral AOM without otorrhea?
Observation, with initiation of antibiotic therapy only if the child worsens or fails to improve within 48-72 hours of onset.
What is the recommended initial management of children ≥2 years of age with unilateral or bilateral AOM without otorrhea?
Observation, with initiation of antibiotic therapy only if the child worsens or fails to improve within 48-72 hours of onset.
What is the definition of recurrent acute otitis media?
≥3 episodes in a 6 month period or ≥4 episodes in a 12 month period.
What is the recommended treatment for patients diagnosed with recurrent otitis media?
Prophylactic antibiotics (amox 40 mg/kg/day or sulfisoxazole 50 mg/kg/day) or tympanostomy tube placement.
What is otitis media with effusion and what is its typical clinical course?
It is a middle ear effusion without associated signs of infection. Spontaneous resolution typically occurs within 6 weeks.
Define chronic suppurative otitis media.
Chronic suppurative otitis media refers to a perforated tympanic membrane with chronic drainage lasting >6 weeks.
Which pathogens are typically implicated in chronic suppurative otitis media?
Pseudomonas and proteus
What is the typical treatment for chronic suppurative otitis media?
Ototopical therapy with a quinolone (5 drops 3x/day for 2 weeks).
What is a cholesteatoma?
An abnormal growth of squamous epithelium in the middle ear. Diagnosis is made on otoscopic exam when a white mass is visualized behind an intact ear drum.
What are the worrisome complications of cholesteatoma?
Progressive growth can destroy the nearby ossicles, this causing hearing loss. It can also cause cranial nerve palsies and vertigo.
In what patients is cholesteatoma more likely to be found?
Cholesteatoma occurs more commonly in children with recurrent or chronic otitis media, cleft palate, Trisomy 21, and Turner syndrome.
What is the treatment for cholesteatoma?
Surgical removal is required, but there is >50% recurrence rate within 5 years of surgery.
Define mastoiditis.
Mastoiditis occurs when the mastoid air cells of the temporal bone, which are contiguous with the middle ear cavity, become infected.
What are the 3 most common pathogens in mastoiditis?
S. pneumoniae, S. pyogenes, and S. aureus.
Describe the physical exam features typical of mastoiditis?
Fever; postauricular erythema, tenderness, and swelling; and protrusion of the auricle.
What is the recommended treatment for uncomplicated mastoiditis?
IV Vancomycin +/- Ceftazidime or Cefepime until typanocentesis culture results are back. Once there is clinical improvement and culture results are known, the patient may be transitioned to oral antibiotics.
At what decible threshold is a child considered to be deaf?
Deafness is defined as hearing loss at >90 dB.
What is the definition of “mild” hearing loss?
“Mild” hearing loss is defined as a 25 dB hearing loss, but even a 15 dB loss can result in problems with speech perception, especially during early childhood.
What is the pattern of inheritance for the majority of inherited deafness cases?
Deafness is inherited in ~50% of cases. Of these, 80% are inherited as autosomal recessive, 18% as autosomal dominant, and 2% as X-linked recessive.
If a patient presents with syncope and hearing loss, what diagnosis should be suspected?
Jervell and Lange-Nielsen syndrome, which is a type of prolonged QT syndrome.
What are the most common causes of conductive hearing loss in children?
Cerumen impaction, ossicular chain fixation, and fluid in the middle ear.
What is the cause of conductive hearing loss?
Conductive hearing loss is due to disruption of mechanical components required for the transduction of sound wave energy.
What is the cause of sensorineural hearing loss?
Sensorineural hearing loss is caused by dysfunction of the sensory epithelium, cochlea, or neural pathways leading to the auditory cortex via CN 8 and other connections.
What is the most likely etiology for severe and profound hearing loss?
Severe and profound hearing loss is always sensorineural and most often affects higher frequencies.
What is the most common infectious cause of congenital deafness?
CMV is the most common infectious cause of congenital deafness. It causes sensorineural hearing loss in 60% of symptomatic infants and 7% of asymptomatic infants.
Name four congenital infections which can cause sensorineural hearing loss.
CMV, toxoplasmosis, rubella, and syphilis.
List 9 risk factors for hearing loss in neonates.
FH of sensorineural hearing loss, congenital infection (especially CMV), presence of craniofacial anomalies, birth weight <1,500 g, neonatal jaundice requiring exchange transfusion, exposure to ototoxic medications, bacterial meningitis, Apgar scores ≤3 at 5 minutes, and physical findings consistent with a syndrome associated with hearing loss.
What should you suspect in a child with hearing loss and a normal tympanogram?
Sensorineural hearing loss.
What should you suspect in a child with hearing loss and a shallow tympanogram?
Ossicular fixation, TM scarring, or otosclerosis.
What should you suspect in a child with hearing loss and a retracted or poorly mobile tympanogram?
Fluid behind the middle ear or perforation of eardrums.
What should you suspect in a child with hearing loss and a negative pressure tympanogram?
Eustachian tube dysfunction
How would you describe the tympanic membrane associated with this tympanogram? Fig 21-1***
Normal
How would you describe the tympanic membrane associated with this tympanogram? Fig 21-2 ***
Shallow
How would you describe the tympanic membrane associated with this tympanogram? Fig 21-3***
Disarticulation
How would you describe the tympanic membrane associated with this tympanogram? Fig 21-4***
Retracted, poorly mobile
How would you describe the tympanic membrane associated with this tympanogram? Fig 21-5***
Negative Pressure
