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Unit 2- Clin Med > Ear infections > Flashcards

Ear infections Flashcards

1
Q

when do you consider a Tympanostomy tube

A

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

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2
Q

what does tympanometry measure

A

compliance/ resistance of middle ear in response to air pressure

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3
Q

maceration

A

skin breakdown

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4
Q

tx of OME

A

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

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5
Q

highlighted tx for labyrinthitis

A

antihistamines/ anticholinergics- meclizine (antivert) 25 mg TID

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6
Q

contraindications for amoxicillin tx with AOM

A

risk of resistant organism (received abx in last 30 days, concurrent purulent conjunctivitis (H. influenzae), hx of resistance to amoxicilin)

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7
Q

labyrinthitis is commonly associated with this pathology

A

viral infections (preceding URI)

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8
Q

otitis externa prophylaxis

A

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

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9
Q

symptomatic tx of otitis externa

A

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

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10
Q

tx of eustachian tube dysfxn

A

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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11
Q

tympanogram of OME

A

type B pattern

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12
Q

tx for AOM in pts with PCN allergy or treatment failure

A

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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13
Q

when do you refer to ENT for tympanosotomy with OME

A

persistent fluid and or hearing loss > 3 months duration or a child at risk of speech/ language/ learning probs

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14
Q

intracranial spread of malignant OE leads to

A

meningitis, brain abscess, sepsis

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15
Q

TM perforations are (painful/ not painful)

A

either

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16
Q

afebrile, AMBER/ STRAW COLORED FLUID behind TM, AIR FLUID LEVELS and bubbles, neutral or RETRACTED TM, conductive hearing loss, immoblie TM

A

clinical presentation of OME

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17
Q

pseudomonas discharge

A

green

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18
Q

otitis externa spread from EAC to skull base

A

malignant otitis externa aka necrotizing external otitis

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19
Q

mortality with malignant OE

A

10-20% (previously 50%)

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20
Q

if sxs of AOM worsen after 48-72 hours

A

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

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21
Q

etiology of malignant otitis externa

A

pseudomonas

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22
Q

___ is indicative of an injury to the inner ear

A

vertigo

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23
Q

diagnosis of malignant otitis externa

A

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

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24
Q

tx for AOM in pts with suspected abx resistance

A

augmentin

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25
Q

treatment for malignant otitis externa

A

ADMIT TO HOSPITAL, C&S OF EAR DISCHARGE, IV CIPROFLOXACIN, (can advance to oral cipro w/ improvement), debridement

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26
Q

symptomatic tx for AOM

A

tylenol/ motrin, fluids

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27
Q

tx for chronic otitis media

A

refer to ENT

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28
Q

criteria for diagnosis of AOM in child

A
  • 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
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29
Q

contraindicated for TM perforation

A

cortison otic suspension

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30
Q

TM is: BULGING (distorted, loss of landmarks), SIGNS OF INFLAMMATION, POOR MOBILITY in physical exam with

A

AOM (adults and kids)

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31
Q

TM will ____ with peumotic otoscopy when perforated

A

not move

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32
Q

otitis externa presentation

A

otalgia, pruritis, discharge, erythematous, edematous, conductive hearing loss

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33
Q

PSEUDOMONAS AERUGINOSA, staph epidermis, staph aureus, asperigillus niger, candida albicans

A

etiology of otitis externa

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34
Q

with AOM you may also see

A

conjunctivitis, rhinorrhea, ear discharge, vomiting, diarrhea

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35
Q

inflammation or blockage resulting in negative middle ear pressure

A

eustachian tube dysfunction

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36
Q

in pure vestibular neuritis hear is

A

preserved

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37
Q

etiology of AOM

A

streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis

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38
Q

benign, acute inflammation/ infection of the vestibular system

A

labyrinthitis

39
Q

etiology of chronic otitis media

A

recurrent AOM, trauma, cholesteatoma, pseduomonas, MRSA

40
Q

TM perforations are associated with ___ hearing loss

A

conductive

41
Q

myringotomy (tympanostomy) tubes used for ____

A

recurrent infections

42
Q

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

A

chronic otitis media

43
Q

“EAR FULLNESS AND DECREASED HEARING; USUALLY PAINLESS”

44
Q

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

A

a month, it can contribute to speech delays

45
Q

meningitis, encephalitis, brain absecess

A

intracranial complications with AOM

46
Q

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

A

acute otitis media (AOM)

47
Q

otalgia, decreased hearing, rare fever

A

adult pt with AOM

48
Q

vestibular neuritis/ neuronitis aka

A

labyrinthitis

49
Q

tx for mastoiditis

A

IV antibiotics, ENT consult, mastoidectomy

50
Q

who’s at risk for malignant otitis externa

A

elderly diabetic & immunocompromised

51
Q

must refer with ____ OME to ENT to rule out

A

refer, nasopharyngeal carcinoma

52
Q

fungal discharge

A

fluffy bread mold, white/ black

53
Q

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

A

clinical presentation of eustachian tube dysfunction

54
Q

treat AOM w/ abx if

A

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

55
Q

chronic infection of middle ear with non intact TM and otorrhea

A

chronic otitis media

56
Q

2nd line treatment for AOM

A

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

57
Q

tympanosclerosis

58
Q

tx for otits externa bacterial

A

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

59
Q

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

A

head thrust

60
Q

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

A

mastoiditis

61
Q

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

A

pediatric pt with AOM

62
Q

when do you recheck AOM

63
Q

indicated for TM perforation

A

floxin otic solution

64
Q

bullous myringitis

A

inflammation of TM w/ bulla formation

65
Q

tx for recurrent AOM

A

augmentin/ ceftriaxone

66
Q

tx for otitis externa fungal

A

clotrimazole, acetic acid (acidifying soln)

67
Q

TM perforations associated with ___ OM

A

acute or chronic

68
Q

severe signs and sxs with AOM

A

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

69
Q

systemic complications with AOM

A

bacteremia

70
Q

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

A

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

71
Q

first line of treatment for AOM

A

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

72
Q

otitis media

A

infection of the middle ear

73
Q

causes of otitis externa

A

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

74
Q

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

A

conductive hearing loss

75
Q

staph discharge

76
Q

indication of progressive osteomyelitis

A

CN nerve involvment with malignant OE

77
Q

how to tx if otitis externa has EAC swelling

A

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

78
Q

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

A

intratemporal complications with AOM

79
Q

etiology of OME

A

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

80
Q

do not treat AOM sxs w/

A

decongestants/ antihistamines- esp not kids < 4 yo

81
Q

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

A

labyrinthitis presentation

82
Q

in kids eustachian tube is ___ until ___

A

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

83
Q

cholesteatoma

A

keratinized, desquamated epithelial collection in the middle ear or mastoid

84
Q

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

A

presentation of malignant otitis externa

85
Q

dx of eustachian tube dysfunction

A

clinical exam, TYMPANOGRAM TYPE C

86
Q

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

A

actue otitis media (AOM) aka supprative otitis media

87
Q

swimmers ear

A

otitis externa

88
Q

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

A

10-14 days, severe localized otalgia

89
Q

quanititative measure of TM mobility done with ___

A

tympanometry- done by specialist

90
Q

worse with movement of the external ear, esp tragus

91
Q

other tx for labyrinthitis

A

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

92
Q

in labyrinthitis hearing is

A

unilaterally lost

93
Q

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

A

risk factors for AOM

94
Q

OME

A

otitis media with effusion aka serous, secretory or nonsuppurative OM

Unit 2- Clin Med (6 decks)

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