Ear Doe

Question 1

MC cerumenolytic:

Answer 1

Carbamide peroxide 6.5% (debrox)

Question 2

Tx for otitis externa

Answer 2

Ciprodex otic (combined agent ciprofloxacin-dexamethasone) applied topically
Ofloxacin
Corisporin otic
Neomycin sulfate
Polymixin B
Pediotic
if infx beyond external canal, then Rq. oral Abx
Protect from moisture/trauma
Acidification with a drying agent (vinegar/isopropyl alcohol)
If no improvement in 48h, Rq ENT consult
Treatment pearls

Question 3

Tx for fungal otitis externa

Answer 3

Clotrimazole gtts or powder
Keep ears dry!!
Thorough cleaning
2% acetic acid gtts/steroid
MC w. Candida and aspergillus

Question 4

MOE tx

Answer 4

1- emergent ENT consult; CT scan; admission
2- IV/PO cipro
3- abx continued for 6-8 weeks until gallium scan shows reduction in inflammatory process
4- surgical debridement

Question 5

Serous otitis media tx

Answer 5

• corticosteroids (prednisone) and/or oral abx (amoxicillin) or combo antihistamines
• if meds fail, ventilating tube can be placed to relieve pressure and aural fullness (PE tube)
• endoscopic laser expansion of the nasopharyngeal orifice of the e tube

Question 6

Aom tx: peds

Answer 6

Pediatric: Rq. Abx if 6 mo or older w/ aom; 6-24 mo b/l aom; greater than 2 yo w/ toxic, moderate otolgia or otalgia>48 hours, temp of 102.2 or higher, and b/l otorrhea

1- Amoxicillin is the abx of choice (unless received within 30d, child w. concurrent purulent conjunctivitis, or the child is allergic to PCN)–> then child Rq. Beta lactamase coverage
2- amox-clav (augmentin)- 1st line if child on amox in same month
3- cephalosporins: cefdinir (omnicef)
Standard 10 day course:
- kid less than 2; tm perf; severe or recurrent illness
Short duration: 5-7d course
- greater than 2; mild dz; minimal evidence
– recurrent may Rq. Tympanostomy
Also pain management: ibuprofen; acetaminophen

Question 7

Aom tx: adults

Answer 7

1- first line: amoxicillin
2- first line w. PCN allergy: macrolides (erythromycin, azithromycin, clarithromycin)
3- 2nd line: amox-clav or cephalosporin 2nd generation

Question 8

Recurrent aom definition

Answer 8

3 episodes of aom in 6 months w/ complete resolution or 4 in 12 months

Question 9

Mechanism of hearing

Answer 9

Stirrup vibrates–> oval window & cochlear fluids move–>stimulate tectoral membrane at organ of corti –> pull hairs in basilar membrane–> cochlear nerve–> medulla oblongata–> midbrain–> auditory cortex of temporal lobe

Question 10

Cerumenolytic agents

Answer 10

Hydrogen peroxide
Sodium bicarbonate in water or glycerine
Cerumen (arachnids oil, turpentine, dichlorbenzene)
Cerumenex (triethanolamine, polypeptides, and oleate-condensate)
Docusate
Mineral oil

Question 11

Cerumen provides this kind of environment

Answer 11

Hydrophobic and acidic for protection