Ear Infections Flashcards
Most common cause of OE
- Pseudomonas aeruginose (38%)
2. Staph epidermidis/staph aureus (9%, 8%)
during physical exam, otalgia in OE can be felt where?
during palpation of the tragus
Discharge color for OE bacteria
Green = pseudomonas
yellow = staph
EAC in OE is found to be…
erythematous, edematous
What type of hearing loss is present in OE?
conductive if marked swelling or significant discharge
1st line txs for bacterial OE?
if no TM perf: cortisporin otic - 2 abx and CS
If TM perf: floxin otic
Ciprodex suspension
Solution vs suspension for OE
suspension is less acidic. Rx when possible (i.e. cortisporin suspension)
Tx options for fungal OE
- clean EAC, apply clotramazole 1% BID x 10-14 days
What can you tell pts to prevent OE?
- acidify EAC with 2% acetic acid solution, or 50:50 mix of water and white vinegar
- dry ear w/ isopropyl alcohol or hair dryer after wetting
Who is most at risk for malignant OE?
- elderly diabetic pts.
Classic findings of malignant OE?
- red granulation tissue in EAC
2. nocturnal pain and with chewing
What to watch for in malignant OE?
- involvement of CN 7, which would indicate progressive osteomyelitis
How do you diagnose malignant OE?
- CT to show bone erosion–distinguishing factor of malignant OE from normal OE
how should a PA treat a pt after diagnosing w/ malignant OE?
- admit to hospital, C&S of ear discharge
2. IV ciprofloxacin
What are the 3 types of OM?
- Otitis media w/ effusion
- acute otitis media
- chronic otitis media
A pt. enters the clinic w/ recent hx of AOM compaining of decreased hearing and a feeling of ear fullness. Pt. denies pain, appears well, and is afebrile. What is your suspected diagnosis?
Otitis media w/ effusion.
-these patients typically have recent AOM and no acute sxs
What would you expect to find on inspection of TM in a patient with OME
- amber colored fluid behind TM
- air-fluid levels and bubbles
- retracted TM
- Type B tympanogram
What should you do for a patient w/ persistant unilateral OME?
- Refer to ENT to rule out nasopharyngeal carcinoma
When to refer to ENT w/ OME?
- fluid or hearing loss > 3 mo
2. children at risk for speech/language/learning problems
How do you manage OME?
- watchful waiting or ENT referral for T tube placement
What distinguishes eustachian tube dysfunction from OME?
- ET dysfunciton has type C tympanogram
Etiology of ET dysfunction
- inflammation or blockage resulting in negative middle ear pressure
Clinical findings of ET dysfunction?
retracted TM, prominent bony landmarks.
ET dysfunction Tx
- steroid nasal spray, allergy management, nasal decongestant, T-tube placement.
- afrin may help prevent barotrauma
What is the peak incidence of AOM?
6-18 mo old.
What usually precedes AOM?
viral URI (RSV)
3 most common pathogens for AOM
- strep. pneumoniae (50%)
- haemophilus influenzae (40%)
- moraxella catarrhalis (10%)
Peds pt. w/ suspected AOM will present w/…
- ear pain and tugging on ear
- anorexia and irritability
- hearing loss/er fullness
- conjunctivitis due to H. Flu
Physical exam findings w/ AOM
- bulging TM
- TM erythema
- Poor mobility of TM
criteria for AOM diagnosis in children 6 mo-12 years
Any of the following:
- moderate/severe TM bulging
- new otorrhea not due to OE
- mild TM bulging and either 48 hr ear pain or intense TM erythema
When do you treat AOM w/ antibiotics?
- < 6 mo
- children with:
moderate-severe otalgia
otalgia > 48 hrs
temp > 102.2 - < 24 months w/ bilateral AOM
1st line Tx for AOM
- Amoxicillin 90mg/kg/day Q12 hrs x 7-10 days
When do you resort to second line treatment for AOM?
- pt. had amoxicillin w/in 30 days
- concurrent purulent conjungtivitis
- recurrent AOM hx
- penicillin allergy
2nd line for AOM
- Augmentin 90mg/kg (amoxicillin) & 6.4mg/kg clavulanate
AOM tx if PCN allergy
- mild: oral or IM cephalosporins
2. Serious: macrolides (mycins)
Precaution regarding sx treatment of AOM
avoid OTC cough and cold prep in children < 4 yrs
What should you tell pts about AOM?
pain and fever should resolve w/ in 3 days
hearing loss may take a month to resolve
What happens if tx for AOM fails?
after 48-72 hours:
initiate or change abx to augmentin PO or ceftriaxone 50mg/kg IM (QD x 2-3 days)
What constitutes recurrent AOM?
- development of s/s w/in 30 days of successful treatment.
How to treat recurrent AOM?
- < 15 days use ceftriaxone
2. > 15 days use augmentin
When to consider T-Tubes to treat recurrent AOM
3 or more episodes of AOM in 6 months
4 or more episodes of AOM in 12 months
common complications of AOM
- conductive hearing loss
- TM perf
- COM
- tympanosclerosis
- cholesteatoma
- mastoiditis
- acute labrynthitis
Type B tympanogram means…
little or no mobility
fluid or TM perf
Type C tympanogram means…
retracted TM, usually ET dysfunction
Pt. complains of hearing loss, fluid draining from ears and vertigo w/ hx of COM. What do you suspect?
- TM perforation
What constitutes COM?
- drainage from ME for 2 or more weeks and painlessTM perforation
Etiology of COM?
recurrent AOM, trauma, cholesteatoma, pseudomonas, MRSA.
Tx for COM?
ENT referral
On inspection of TM, you notice white plaques on the TM absent any other pathologic features. What is this?
tympanosclerosis due to frequent ME infection
What is a cholesteatoma?
abnormal growth of squamous epithelium in middle ear and mastoid.
progressively enlarge and destroy ossicles
A patient presents w/ post-auricular pain, edema and erythema. There is a mass which appears to be protruding the pinna and fever. what do you suspect?
mastoiditis
How do you treat mastoiditis
- IV abx and mastoidectomy
What distinguishes vestibular neuritis from labyrinthitis?
labyrinthitis there is unilateral hearing loss.
what is the hypothesized etiology of labyrinthitis?
viral or postviral inflammation of vestibule
What sxs do you expect w/ labyrinthitis?
- acute onset of severe vertigo
- N/V
- Unilateral hearing loss
- no CNS deficits
What test confirms labyrinthitis
+ Head Thrust:
cannon maintain visual fixation when head turned to affected side.
