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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
Q

What is the treatment for malignant otitis externa?

A

Admit to hospital

Culture and sensitivity of discharge

IV Ciprofloxacin

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26
Q

What are the three types otitis media?

A

Otitis Media with Effusion (OME)

Acute Otitis Media (AOM)

Chronic Otitis Media

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27
Q

What type of Otitis media:

Middle ear fluid without symptoms of illness

Painless***

Recent AOM, URI, allergies etc**

Ear fullness

Decreased hearing

A

Otitis media with effusion (OME)

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28
Q

What will the TM look like in Otitis media with effusion

A

AMBER or STRAW colored fluid behind TM

Air-fluid levels and bubbles

Retracted TM or neutral TM

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29
Q

What type of Tympanogram will Otitis media with effusion have?

A

Type B- eardrum will not move with pneumatic otoscopy

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30
Q

What should you do if an adult has persistent unilateral Otitis media with effusion?

A

Refer to ENT to rule out nasopharyngeal carcinoma (tumor may be obstructing Eustachian tube)

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31
Q

How do you treat otitis media with effusion?

A

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

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32
Q

What kind of middle ear pressure will Eustachian tube dysfunction cause?

A

Negative middle ear pressure

33
Q

What are some of the symptoms of Eustachian tube dysfunction?

A

Ear fullness

Recurrent OME

Hearing loss

34
Q

What will the TM look like in eustachain tube dysfunction?

A

Retracted with prominent bony landmarks

35
Q

What kind of tympanogram will eustachain tube dysfunction have?

A

Type C

36
Q

What is the treatment for Eustachian tube dysfunction?***

A

Steroid nasal spray

Manage allergies

Decongestants (if using topical nasal decongestants, limit to 3 days)

T-tubes

37
Q

Are mastoid air cells involved in acute otitis media?

A

Yes

38
Q

What are the most common pathogens to cause acute otitis media?***

A

Streptococcus pneumoniae (50%)

Haemophilus influenzae (40%)

Moraxella catarrhalis (10%)

Must know all 3

39
Q

What is one of the main differences between adult and pediatric patients with acute otitis media?

A

Kids usually have fever, adults don’t

40
Q

What do you think it is:
Ear pain/tugging on ears

Fever

Poor feeding

Irritability/not sleeping

Hearing loss

A

Acute otitis media in a pediatric patient

41
Q

What will the tympanic membrane look like with acute otitis media?

A

Bulging

Signs of inflammation-red

Poor mobility

Conductive hearing loss (Weber test)

42
Q

What is vascular engorgement on the TM?

A

Vessels on perimeter of TM are engorged, usually due to a kid being upset/crying

NOT otitis media. Nothing is wrong

43
Q

What does “myringitis” mean?

A

Inflammation of the TM

44
Q

What might happen to the ear 10-14 days after a viral infection?

A

Bullous myringitis (blisters on TM)

Severe pain

45
Q

How do you treat bullous myringitis?

A

Same as for Acute otitis media

46
Q

What is the difference between pneumatic otoscopy and tympanometry?

A

Pneumatic otoscopy- qualitative information about TM mobility. PCP can do this

Tympanometry- provides quantitative measure of TM mobility. Done by ENT/audiologist.

47
Q

What is a Type A tympanogram?

A

Normal. TM moves in both directions

48
Q

What is a type B tympanogram?

A

TM doesn’t move at all due to fluid or TM perforation

49
Q

What is a type C tympanogram?

A

Retracted TM due to Eustachian tube dysfunction

50
Q

Who should be treated with antibiotics for AOM?

A

<6 months of age

Severe symptoms: mod-severe pain, pain for over 48 hrs, 102.2 fever

Bilateral AOM in kids under 2

51
Q

Who should maybe not get antibiotics for AOM?

A

Children 6-24 months with unilateral non-severe AOM

Children over 2 with unilateral or bilateral non-severe AOM

52
Q

If the pt is 12 months old and has bilateral, non-severe AOM, should they get antibiotics?

A

Yes, bilateral infections get antibiotics regardless of severity until they’re 24 months

53
Q

If a patient is over 6 months old and has a unilateral AOM with non-severe symptoms, should he get antibiotics?

A

No.

Non-severe AOM gets abx only if under 6 months, OR the infection is bilateral and pt is under 2

54
Q

What is the first line treatment for AOM?

A

Amoxicillin 90mg/kg/day divided q 12 hrs

7-10 days

55
Q

When should you not use amoxicillin for AOM?

A
  • 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
Q

What is the 2nd line treatment for AOM if amoxicillin is not a good choice?

A

Augmentin (amoxicillin + clavulanate)

90mg/kg/day amoxicillin

57
Q

What is the 3rd line treatment for AOM if pt is allergic to PCN or it didn’t work?

A 
Oral:
Cefdinir
Cefuroxime
Cefpodoxime
Azithromycin (only if PCN allergy is severe)

IV/IM:
Ceftriaxone 50mg once a day for 1-3 days

58
Q

Are decongestants and antihistamines helpful for AOM treatment?

A

NO, unless you have known nasal allergies

59
Q

Should you use OTC cold medicine for kids under 4 yo?

A

No

60
Q

What should you do if your AOM patient is not getting better after 2-3 days?

A
  • initiate abx if you decided to watch and wait
  • change antibiotic if you gave it
  • consider IM ceftriaxone or ENT referral for tympanocentesis
61
Q

How long will it take for hearing loss due to AOM to resolve?

A

Can take up to 1 month

62
Q

Do you need to recheck every patient that you treated for AOM?

A

Yes, recheck everyone 7-10 days later

63
Q

What is recurrent acute otitis media?

A

Development of more AOM soon after successful treatment for AOM

64
Q

How should you treat recurrent acute otitis media?

A

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
Q

What is chronic otitis media?

A

Painless TM perforation with drainage for at least 2 weeks

66
Q

How do you treat chronic otitis media

A

Refer to ENT.

67
Q

Does chronic acute otitis media hurt?

A

Not usually

68
Q

Do most TM perforations heal on their own?

A

Yes.

69
Q

What is tympanosclerosis?

A

Scarring of the TM. Not concerning

70
Q

Name this: keratinzed, desquamated, epithelial collection in the middle ear or mastoid

A

Cholesteatoma

Basically skin cells collecting in a sac

71
Q

Name this:
**Post-auricular pain, swelling and redness

Squishy mass behind ear

Fever

Pain

Protrusion of pinna

A

Mastoiditis

72
Q

What is the treatment for mastoiditis?m

A

IV antibiotics**

ENT consult for possible mastoidectomy**

(These people are hospitalized)

73
Q

If a pt with AOM has outwards and downwards protrusion of the pinna what should you be worried about?

A

Mastoiditis

74
Q

What are the other names for labyrinthitis?

A

Vestibular neuritis/neuronitis

75
Q

What is labyrinthitis?

A

Benign inflammation of vestibular system

76
Q

What is labyrinthitis most commonly associated with?

A

Viral infections (preceding URI)**

77
Q

Name this:
Severe vertigo

Unilateral hearing loss

Horizontal nystagmus

+Head Thrust test

N/V

No CNS deficits

A

Labyrinthitis

78
Q

What is a positive head thrust?

A

Patient can not maintain visual fixation when you turn their head

79
Q

How do you treat labyrinthitis?

A

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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