Ear infections Flashcards
when do you consider a Tympanostomy tube
3 + episodes of AOM in 6 months or 4+ in 12 months
what does tympanometry measure
compliance/ resistance of middle ear in response to air pressure
maceration
skin breakdown
tx of OME
spontaneous resolution, watchful waiting (4-6 wks), intranasal steroids (underlying rhinitis), refer to ENT for T-tubes
highlighted tx for labyrinthitis
antihistamines/ anticholinergics- meclizine (antivert) 25 mg TID
contraindications for amoxicillin tx with AOM
risk of resistant organism (received abx in last 30 days, concurrent purulent conjunctivitis (H. influenzae), hx of resistance to amoxicilin)
labyrinthitis is commonly associated with this pathology
viral infections (preceding URI)
otitis externa prophylaxis
2% acetic acid (VoSol), homemade vinegar soln, use bathing cap/ ear plugs
symptomatic tx of otitis externa
pain control, keep canal dry, self limiting (5-7 days)
tx of eustachian tube dysfxn
STEROID NASAL SPRAY, MANAGEMENT OF ALLERGIES, DECONGESTANTS, T-TUBES, topical nasal decongestants (neo-synephrine, afrin)- limited to 3 days to avoid rebound congestion
tympanogram of OME
type B pattern
tx for AOM in pts with PCN allergy or treatment failure
oral:
cefdinir (OMNICEF),
cefuroxime (CEFTIN),
cefpodoxime (VANTIN),
azithromycine (ZITHROMAX) **azithromycin contraindicated for tx failure
IM/IV: ceftriaxone (Rocephin)- 50 mg IM/ IV daily x 3 days
when do you refer to ENT for tympanosotomy with OME
persistent fluid and or hearing loss > 3 months duration or a child at risk of speech/ language/ learning probs
intracranial spread of malignant OE leads to
meningitis, brain abscess, sepsis
TM perforations are (painful/ not painful)
either
afebrile, AMBER/ STRAW COLORED FLUID behind TM, AIR FLUID LEVELS and bubbles, neutral or RETRACTED TM, conductive hearing loss, immoblie TM
clinical presentation of OME
pseudomonas discharge
green
otitis externa spread from EAC to skull base
malignant otitis externa aka necrotizing external otitis
mortality with malignant OE
10-20% (previously 50%)
if sxs of AOM worsen after 48-72 hours
repeat ear exam, change abx, consider IM rocephin or refer for tympanocentesis
etiology of malignant otitis externa
pseudomonas
___ is indicative of an injury to the inner ear
vertigo
diagnosis of malignant otitis externa
CT- best (bone erosion present with malignant OE), also elevated ESR and/or CRP, maybe MRI
tx for AOM in pts with suspected abx resistance
augmentin
treatment for malignant otitis externa
ADMIT TO HOSPITAL, C&S OF EAR DISCHARGE, IV CIPROFLOXACIN, (can advance to oral cipro w/ improvement), debridement
symptomatic tx for AOM
tylenol/ motrin, fluids
tx for chronic otitis media
refer to ENT
criteria for diagnosis of AOM in child
- moderate to severe bulging TM - new onset otorrhea not due to acute OE - mild bulging TM and ear pain (<48 hours) or intense erythema of the TM
contraindicated for TM perforation
cortison otic suspension
TM is: BULGING (distorted, loss of landmarks), SIGNS OF INFLAMMATION, POOR MOBILITY in physical exam with
AOM (adults and kids)
TM will ____ with peumotic otoscopy when perforated
not move
otitis externa presentation
otalgia, pruritis, discharge, erythematous, edematous, conductive hearing loss
PSEUDOMONAS AERUGINOSA, staph epidermis, staph aureus, asperigillus niger, candida albicans
etiology of otitis externa
with AOM you may also see
conjunctivitis, rhinorrhea, ear discharge, vomiting, diarrhea
inflammation or blockage resulting in negative middle ear pressure
eustachian tube dysfunction
in pure vestibular neuritis hear is
preserved
etiology of AOM
streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis