Ear infection

Question 1

otitis externa (swimmer’s ear) pathophysiology

Answer 1

the disruption of the normally acidic auditory canal by damage to the epithelium, loss of protective wax, and accumulation of moisture leads to higher pH and bacterial growth.

Question 2

s/s of otitis externa

Answer 2

edema, tender pinna, pruritus
otorrhea
pre/postauricular pymphadenopathy
tympanic membrane is intact

Question 3

Risk factors of otitis externa

Answer 3

swimming, diabetes, immune compromised, devices in ear

Question 4

elements

Question 5

cone of light (otoscope) location

Answer 5

5 clock in the right ear
7 clock in the left ear

Question 6

elements of diagnoses for otitis externa

Answer 6

1. rapid onset (typically within 48 hrs)
2. sym[toms of ear canal inflammation such as mild to severe ear pain, itching, or fullness
   w or w/o hearing loss; pain can be worse with chewing or jaw mvnt
3. signs of ear canal inflammation
   w or w/o otorrhea, local swelling of the lymphnode, tympenic membrane erythema, cellulitis of pinna

Question 7

Rx treatment for otitis externa

Answer 7

OTC (Polysporin) otic/ophthalmic drops
Rx: Ciprodex otic drops
(stop with hearing loss, vertigo or tinnitus)

Question 8

Otomycosis Rx

Answer 8

Clotrimazole 1% cream
Tolnaftate 1% cream
Flumethasone pivalate 0.02% and clioquinol 1% ear drops (Locacorten Vioform)

Question 9

which organism causing necrotizing/malignant otitis externa?

Answer 9

pseudomonas aeruginosa

Question 10

What to do with necrotizing/malignant otitis externa?

Answer 10

referral to ED for IV therapy (then PO4-8 weeks)

Question 11

otitis media treatment for children > 2 years old

Answer 11

oral analgesia for 48-72 hours
if symptoms persist, verify the diagnosis of OM
treat for 5 days

Question 12

treatment for otitis media for children 6 mo to 2 yrs

Answer 12

oral analgesia for 48-72 hrs
if symptoms persist, verify the diagnosis of OM
treat for 10 days

Question 13

treatment for otitis media if children , 6 mo

Answer 13

watchful waiting is not appropriate if AOM is reasonably certain
treat 10 days

Question 14

otitis media Rx for adults with TM intact
1st and 2nd line

Answer 14

1st line: amoxicilin
2nd line: amoxiclav, cefprozil, cefuroxime, TMP/SMX

Question 15

Rx for otitis media in adults with perforation or tube

Answer 15

1st: ciprodex ear drops

Question 16

Rx for children with OM TM intact
1st line
2nd line

Answer 16

1st line: amoxicillin (higher dose 80-90mg/kg/day) for 2 years or younger, in daycare, or on abx in past 4 months
standard 40-60mh/kg/day
2nd line: amoxciclav, cefprozil
3rd: cefuroxime, clarithromycin, azithromycin

Question 17

children with OM with perforation or tubes RX

Answer 17

1st: cirpodex otic drops
cipro/fluocinolone (otixal) for children with tube > 6 month

Question 18

whats mastoiditis

Answer 18

the inflammation of the portion of temporal bone referred to as the mastoid air cells

Question 19

pathophysiology of mastoiditis

Answer 19

the lining of the middle ear cavity is continuous with the lining of the mastoid air cells.
Eustacian tube narrowed due to inflammation.
acute mastoiditis, infection lead to bony septation erosion and coalescence of small air cell into larger ones filled with pus

Question 20

what are the two types of chronic suppurative otitis media (CSOM)?

Answer 20

safe
dangerous: cholesteatoma

Question 21

what are the s/s of chornic suppuratie otitis media (CSOM)?

Answer 21

TM perforation, conductive hearing loss, malodorous aural discharge

Question 22

what’s the sign of mastoiditis?

Answer 22

postauricular erythema

Question 23

what’s the most effective modifiable factor for OME?

Answer 23

exposure to second hand smoke