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Clin Med Exam 2 (Lauren) > Ear Infections > Flashcards

Ear Infections Flashcards

1
Q

What is the other term for Otitis externa

A

Swimmers ear

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2
Q

What causes otitis externa?

A

Breakdown of skin allows bacteria to enter

(Breakdown can be caused by trapped heat/moisture causing maceration, trauma, and skin issues like eczema, psoriasis, seborrheic dermatitis)

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3
Q

What is the most common bacteria to cause otitis externa

A

Pseudomonas aeruginosa

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4
Q

What two fungi species cause 2-10% of otitis externa cases?

A

Asperigillus niger

Candida albicans

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5
Q

What is the clinical presentation of otitis externa?

A

Ear pain, worsens with movement of external ear (especially tragus)

Pruritus

Discharge

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6
Q

What bacteria do you suspect to cause an otitis externa infection if the discharge is green?

A

Pseudomonas

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7
Q

What bacteria do you suspect to cause an otitis externa infection if the discharge is yellow?

A

Staph

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8
Q

What do you suspect to cause an otitis externa infection if the discharge is fluffy like bread mold and black or white

A

Fungal

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9
Q

What is another term for otitis externa caused by fungi?

A

Otomycosis

Will look like bread mold

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10
Q

What is an important thing to note during your exam when you suspect otitis externa

A

Whether or not the TM is intact

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11
Q

What is the first line treatment for Otitis externa

A

Cortisporin Otic Suspension UNLESS the TM is perforated

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12
Q

What is the treatment for bacterial otitis externa if the TM is perforated?

A

Floxin Otic Solution

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13
Q

What is the difference between Otic suspensions and Otic solutions?

A

Otic suspensions are less acidic and cause less irritation to infected tissue

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14
Q

What is another treatment option for bacterial otitis externa (not first line and not for perforated TM)

A

Ciprodex or CiproHC (has a steroid in it that is good if there is a lot of inflammation)

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15
Q

What is the treatment for fungal otitis externa?

A

Clotrimazole 1% BID x 14 days

Acetic acid

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16
Q

What can you do if the EAC is very swollen and medication leaks out?

A

Apply the meds to an ear wick for 2-3 days until swelling goes down

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17
Q

How long does it take for otitis externa to go away

A

Usually 5-7 days

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18
Q

If otitis externa doesn’t improve within 2-3 days, what should you consider?

A

Noncompliance

Otomycosis

Malignant otitis externa

Periauricular cellulitus

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19
Q

How can you prevent otitis externa?

A

Prophylactic solution of vinegar/water

Isopropyl alcohol

Hair dryer

Wear swim cap or ear plugs

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20
Q

Who is most at risk for malignant otitis externa?

A

Elderly diabetics and immunocompromised ppl

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21
Q

What causes 95% of malignant otitis externa?

A

Pseudomonas

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22
Q

Name this:

Red granulation tissue in EAC

Pain often nocturnal and with chewing

A

Malignant otitis externa

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23
Q

What is the best initial test for diagnosis of malignant otitis externa?

A

CT

Bone erosion is the distinguishing feature of malignant vs regular otitis externa

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24
Q

What is the mortality of malignant otitis externa?

A

10-20%

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25
What is the treatment for malignant otitis externa?
Admit to hospital Culture and sensitivity of discharge IV Ciprofloxacin
26
What are the three types otitis media?
Otitis Media with Effusion (OME) Acute Otitis Media (AOM) Chronic Otitis Media
27
What type of Otitis media: Middle ear fluid without symptoms of illness Painless*** Recent AOM, URI, allergies etc** Ear fullness Decreased hearing
Otitis media with effusion (OME)
28
What will the TM look like in Otitis media with effusion
AMBER or STRAW colored fluid behind TM Air-fluid levels and bubbles Retracted TM or neutral TM
29
What type of Tympanogram will Otitis media with effusion have?
Type B- eardrum will not move with pneumatic otoscopy
30
What should you do if an adult has persistent unilateral Otitis media with effusion?
Refer to ENT to rule out nasopharyngeal carcinoma (tumor may be obstructing Eustachian tube)
31
How do you treat otitis media with effusion?
Watchful waiting, usually goes away in 4-6 wks Intranasal steroids if they have allergic rhinitis Refer to ENT if they have persistent fluid/hearing loss >3 months OR if its a child at risk for speech problems
32
What kind of middle ear pressure will Eustachian tube dysfunction cause?
Negative middle ear pressure
33
What are some of the symptoms of Eustachian tube dysfunction?
Ear fullness Recurrent OME Hearing loss
34
What will the TM look like in eustachain tube dysfunction?
Retracted with prominent bony landmarks
35
What kind of tympanogram will eustachain tube dysfunction have?
Type C
36
What is the treatment for Eustachian tube dysfunction?***
Steroid nasal spray Manage allergies Decongestants (if using topical nasal decongestants, limit to 3 days) T-tubes
37
Are mastoid air cells involved in acute otitis media?
Yes
38
What are the most common pathogens to cause acute otitis media?***
Streptococcus pneumoniae (50%) Haemophilus influenzae (40%) Moraxella catarrhalis (10%) Must know all 3
39
What is one of the main differences between adult and pediatric patients with acute otitis media?
Kids usually have fever, adults don’t
40
What do you think it is: Ear pain/tugging on ears Fever Poor feeding Irritability/not sleeping Hearing loss
Acute otitis media in a pediatric patient
41
What will the tympanic membrane look like with acute otitis media?
Bulging Signs of inflammation-red Poor mobility Conductive hearing loss (Weber test)
42
What is vascular engorgement on the TM?
Vessels on perimeter of TM are engorged, usually due to a kid being upset/crying NOT otitis media. Nothing is wrong
43
What does “myringitis” mean?
Inflammation of the TM
44
What might happen to the ear 10-14 days after a viral infection?
Bullous myringitis (blisters on TM) Severe pain
45
How do you treat bullous myringitis?
Same as for Acute otitis media
46
What is the difference between pneumatic otoscopy and tympanometry?
Pneumatic otoscopy- qualitative information about TM mobility. PCP can do this Tympanometry- provides quantitative measure of TM mobility. Done by ENT/audiologist.
47
What is a Type A tympanogram?
Normal. TM moves in both directions
48
What is a type B tympanogram?
TM doesn’t move at all due to fluid or TM perforation
49
What is a type C tympanogram?
Retracted TM due to Eustachian tube dysfunction
50
Who should be treated with antibiotics for AOM?
<6 months of age Severe symptoms: mod-severe pain, pain for over 48 hrs, 102.2 fever Bilateral AOM in kids under 2
51
Who should maybe not get antibiotics for AOM?
Children 6-24 months with unilateral non-severe AOM Children over 2 with unilateral or bilateral non-severe AOM
52
If the pt is 12 months old and has bilateral, non-severe AOM, should they get antibiotics?
Yes, bilateral infections get antibiotics regardless of severity until they’re 24 months
53
If a patient is over 6 months old and has a unilateral AOM with non-severe symptoms, should he get antibiotics?
No. Non-severe AOM gets abx only if under 6 months, OR the infection is bilateral and pt is under 2
54
What is the first line treatment for AOM?
Amoxicillin 90mg/kg/day divided q 12 hrs 7-10 days
55
When should you not use amoxicillin for AOM?
- received abx in last 30 days - have concurrent purulent conjunctivitis - hx of recurrent AOM resistant to amoxicillin (Basically anyone with a high risk of having a resistant organism)
56
What is the 2nd line treatment for AOM if amoxicillin is not a good choice?
Augmentin (amoxicillin + clavulanate) | 90mg/kg/day amoxicillin
57
What is the 3rd line treatment for AOM if pt is allergic to PCN or it didn’t work?
``` Oral: Cefdinir Cefuroxime Cefpodoxime Azithromycin (only if PCN allergy is severe) ``` IV/IM: Ceftriaxone 50mg once a day for 1-3 days
58
Are decongestants and antihistamines helpful for AOM treatment?
NO, unless you have known nasal allergies
59
Should you use OTC cold medicine for kids under 4 yo?
No
60
What should you do if your AOM patient is not getting better after 2-3 days?
- initiate abx if you decided to watch and wait - change antibiotic if you gave it - consider IM ceftriaxone or ENT referral for tympanocentesis
61
How long will it take for hearing loss due to AOM to resolve?
Can take up to 1 month
62
Do you need to recheck every patient that you treated for AOM?
Yes, recheck everyone 7-10 days later
63
What is recurrent acute otitis media?
Development of more AOM soon after successful treatment for AOM
64
How should you treat recurrent acute otitis media?
Augmentin or Ceftriaxone (We’re not gonna do amoxicillin again) Consider T-tubes if: 3+ episodes in 6 months or 5+ episodes in a year
65
What is chronic otitis media?
*Painless TM perforation* with drainage for at least 2 weeks
66
How do you treat chronic otitis media
Refer to ENT.
67
Does chronic acute otitis media hurt?
Not usually
68
Do most TM perforations heal on their own?
Yes.
69
What is tympanosclerosis?
Scarring of the TM. Not concerning
70
Name this: keratinzed, desquamated, epithelial collection in the middle ear or mastoid
Cholesteatoma | Basically skin cells collecting in a sac
71
Name this: **Post-auricular pain, swelling and redness Squishy mass behind ear Fever Pain Protrusion of pinna
Mastoiditis
72
What is the treatment for mastoiditis?m
IV antibiotics** ENT consult for possible mastoidectomy** (These people are hospitalized)
73
If a pt with AOM has outwards and downwards protrusion of the pinna what should you be worried about?
Mastoiditis
74
What are the other names for labyrinthitis?
Vestibular neuritis/neuronitis
75
What is labyrinthitis?
Benign inflammation of vestibular system
76
What is labyrinthitis most commonly associated with?
Viral infections (preceding URI)**
77
Name this: Severe vertigo Unilateral hearing loss Horizontal nystagmus +Head Thrust test N/V No CNS deficits
Labyrinthitis
78
What is a positive head thrust?
Patient can not maintain visual fixation when you turn their head
79
How do you treat labyrinthitis?
Symptomatically: bed rest Antihistamines/anticholinergics-Meclizine 25mg TID (very sedating) Antiemetic-compazine Benzos- diazepam or lorazepam Prednisone

Clin Med Exam 2 (Lauren) (6 decks)

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