Ear infections Flashcards by Rebecca Lea

when do you consider a Tympanostomy tube

3 + episodes of AOM in 6 months or 4+ in 12 months

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what does tympanometry measure

compliance/ resistance of middle ear in response to air pressure

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maceration

skin breakdown

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tx of OME

spontaneous resolution, watchful waiting (4-6 wks), intranasal steroids (underlying rhinitis), refer to ENT for T-tubes

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highlighted tx for labyrinthitis

antihistamines/ anticholinergics- meclizine (antivert) 25 mg TID

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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)

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labyrinthitis is commonly associated with this pathology

viral infections (preceding URI)

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otitis externa prophylaxis

2% acetic acid (VoSol), homemade vinegar soln, use bathing cap/ ear plugs

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symptomatic tx of otitis externa

pain control, keep canal dry, self limiting (5-7 days)

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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

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tympanogram of OME

type B pattern

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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

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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

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intracranial spread of malignant OE leads to

meningitis, brain abscess, sepsis

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TM perforations are (painful/ not painful)

either

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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

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pseudomonas discharge

green

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otitis externa spread from EAC to skull base

malignant otitis externa aka necrotizing external otitis

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mortality with malignant OE

10-20% (previously 50%)

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if sxs of AOM worsen after 48-72 hours

repeat ear exam, change abx, consider IM rocephin or refer for tympanocentesis

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etiology of malignant otitis externa

pseudomonas

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___ is indicative of an injury to the inner ear

vertigo

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diagnosis of malignant otitis externa

CT- best (bone erosion present with malignant OE), also elevated ESR and/or CRP, maybe MRI

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tx for AOM in pts with suspected abx resistance

augmentin

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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

benign, acute inflammation/ infection of the vestibular system

labyrinthitis

etiology of chronic otitis media

recurrent AOM, trauma, cholesteatoma, pseduomonas, MRSA

TM perforations are associated with ___ hearing loss

conductive

myringotomy (tympanostomy) tubes used for \_\_\_\_

recurrent infections

painless TM perforation and drainage from the middle ear for 2+ weeks

chronic otitis media

"EAR FULLNESS AND DECREASED HEARING; USUALLY PAINLESS"

OME

hearing loss make take ____ to resolve, this is import to recognize why

a month, it can contribute to speech delays

meningitis, encephalitis, brain absecess

intracranial complications with AOM

precipitated by a viral URI, eustachian tube obstructed w/ fluid/ mucus --\> infxn, mastoid air cell involvement

acute otitis media (AOM)

otalgia, decreased hearing, rare fever

adult pt with AOM

vestibular neuritis/ neuronitis aka

labyrinthitis

tx for mastoiditis

IV antibiotics, ENT consult, mastoidectomy

who's at risk for malignant otitis externa

elderly diabetic & immunocompromised

must refer with ____ OME to ENT to rule out

refer, nasopharyngeal carcinoma

fungal discharge

fluffy bread mold, white/ black

ear fullness, recurrent OME, hearing loss with RETRACTED TM, prominent bony landmarks

clinical presentation of eustachian tube dysfunction

treat AOM w/ abx if

\< 6 months old \> 6 months, bilateral/ unilateral + severe signs and sxs 6-23 months, bilateral w/out severe sxs

chronic infection of middle ear with non intact TM and otorrhea

chronic otitis media

2nd line treatment for AOM

amoxicillin/ clavulanate (augmentin)- 90 mg/kg amoxicillin & 6.4 mg/kg clavulanate

tympanosclerosis

scarring

tx for otits externa bacterial

1- CORTISPORIN OTIC SUSPENSION (polymixin B, neomycin, hydrocoritisone 2- floxin otic solution (ofloxacin) 3- ciprodex or CirproHC (ciprofloxacin + glucocorticoid)

unable to maintain visual fixation when head moved side to side (affected ear)

head thrust

rare complication of AOM associated with post-auricular pain, edema, erythema, fluctuance/ mass, fever, deep temporal pain, protrusion of pinna

mastoiditis

irritable, restless sleep, poor feeding/ anorexia, fever, EAR PAIN (tugging at ear), hearing loss, ear fullness

pediatric pt with AOM

when do you recheck AOM

7-14 days

indicated for TM perforation

floxin otic solution

bullous myringitis

inflammation of TM w/ bulla formation

tx for recurrent AOM

augmentin/ ceftriaxone

tx for otitis externa fungal

clotrimazole, acetic acid (acidifying soln)

TM perforations associated with ___ OM

acute or chronic

severe signs and sxs with AOM

moderate/ severe otalgia, otalgia \>48 hours, temp \> 39

systemic complications with AOM

bacteremia

middle ear effusion in the ABSENCE OF ACUTE SXS (illness/ inflammation)

otitis media with effusion (OME) aka serous/ secretory/ nonsuppurative OM

first line of treatment for AOM

high dose amoxicillin 90 mg/kg/day divided q 12, x 7-10 days

otitis media

infection of the middle ear

causes of otitis externa

heat/ moisture --\> swelling & maceration + bacteria, trauma, assoc skin diseases

what do you do if there are physical exam findings indicating AOM

conductive hearing loss

staph discharge

yellow

indication of progressive osteomyelitis

CN nerve involvment with malignant OE

how to tx if otitis externa has EAC swelling

ear wick (oto-wick)- remove after 48-72 hours

TM perforation, tympanosclerosis, chronic otitis media, mastoiditis, hearing loss, cholesteatoma, acute labryinthyitis

intratemporal complications with AOM

etiology of OME

RECENT AOM, URI, allergies, eustachian tube dysfxn, barotrauma, nasopharyngeal carcinoma

do not treat AOM sxs w/

decongestants/ antihistamines- esp not kids \< 4 yo

acute onset of severe vertigo (1-2 days), N/V, gait instability, UNILATERAL HEARING LOSS, horizontal nystagmus, HEAD THRUST without CNS deficits, maybe following AOM or meningitis

labyrinthitis presentation

in kids eustachian tube is ___ until \_\_\_

immature, 5/6 y/o, why kids get more ear infxns

cholesteatoma

keratinized, desquamated epithelial collection in the middle ear or mastoid

otalgia and otorrhea that arent responsive to normal OE tx, nocturnal pain, pain with chewing, red granulation in the EAC, periauricular lymphadenopathy, edema, trismus

presentation of malignant otitis externa

dx of eustachian tube dysfunction

clinical exam, TYMPANOGRAM TYPE C

acute illness with middle ear fluid and s/sx of middle ear inflammation

actue otitis media (AOM) aka supprative otitis media

swimmers ear

otitis externa

bullous myringitis manifests ____ after a viral infxn (mycoplasma pneumoniae) and causes \_\_\_

10-14 days, severe localized otalgia

quanititative measure of TM mobility done with \_\_\_

tympanometry- done by specialist

worse with movement of the external ear, esp tragus

otalgia

other tx for labyrinthitis

bed rest, hydration, oral prednisone taper, antiemetics, prochlorperazine, benzos

in labyrinthitis hearing is

unilaterally lost

young age/ immature anatomy, secondhand smoke, lack of breastfeeding, day care, pacifier, season

risk factors for AOM

OME

otitis media with effusion aka serous, secretory or nonsuppurative OM