Ear Infections/Allergic Rhinitis Flashcards
Otitis externa etiology
psuedomonas, staph epi, staph aureus, fungal
ear pain, tender tragus. Pruritis, discharge, erythematous and edematous EAC. Conductive hearing loss
Otitis externa
Otitis externa treatments for bacterial infection (2)
Bacterial: Corticosporin otic suspension (Polymyxin, neomycin, and hydrocortisone)- not for perforated TM
Otic solution for perforated TM, Ciprodex
Otitis externa lifestyle changes
No swimming for 7-10 days
Prophylaxis: vinegar solution or commercial product
intense ear pain and discharge. Red, granulation tissue in the EAC. Possible periauricular lymphadenopathy, trismus
Seen in diabetics and immunocompromised patients
Malignant otitis externa
Malignant otitis externa involves?
Osteomyelitis
Malignant otitis externa treatment
IV antibiotics, wound debridement
Malignant otitis externa etiology
primarily psuedomonas
otalgia, reddened TM w/ decreased mobility, signs of effusion, loss of visible landmarks.
Can be preceded by URI. Ear may feel “full,” may have conductive hearing loss
(adults)
Acute otitis media
otalgia, reddened TM, reduced TM mobility, etc
PLUS fever, irritability, tugging on the ear
(peds)
Acute otitis media in peds
Otitis media etiology
Strep pneumo, mostly
Acute Otitis Media treatment schedule
Age 24 mo w/ severe symptoms and certain AOM diagnosis- Antibiotics
Antibiotics and/or observation for others
Symptomatic care
severe clinical signs of AOM
moderate-severe otalgia, otalgia for at least 48h, or temp of 39 (102.2 F) or higher
Antibiotic dosage for AOM (2)
Amoxicillin 90 mg/kg BID for 7-10 days
Augmentin 90 mg/kg 6.4 mg/kg BID 7-10 days
drainage from the middle ear > 2 weeks & associated TM perforation that is usually painless. Conductive hearing loss
Chronic otitis media
Chronic otitis media etiology
recurrent otitis media, trauma, cholesteatoma
Chronic otitis media tx
refer to ENT
+/- pain, +/- otorrhea, conductive hearing loss, associated with acute/chronic OM, immobile TM
TM perforations
TM perforation tx
heals spontaneously- resulting in tympanosclerosis (scarring)
extension of otitis externa or acute otitis media into mastoid air cells.
Postauricular pain and erythema, fever, deep temporal pain
Mastoiditis
Mastoiditis treatment
IV antibiotics, ENT consult, mastoidectomy
ear fullness, hearing loss. Middle ear effusion secondary to inflammation, URI, Eustachian tube issues
Serous otitis media
Pt. afebrile, amber-colored fluid behind TM, may see bubbles, retraction of TM produces prominent landmarks, immobile TM, possible conductive hearing loss
Serous Otitis Media
Serous otitis media treatment
most resolve spontaneously; topical nasal decongestants may help- No Antibiotics
Serous otitis media referral conditions
refer to ENT for persistent (>3 mo.) cases or for kids
discomfort or damage to ear due to pressure differences between middle ear and external ear
Associated w/ altitude changes, URIs, allergies
Ear barotrauma
Ear barotrauma treatment
prevention- nasal decongestants, antihistamines, Valsalva manuever, chewing gum
benign, acute inflammation or infection of the vestibular system
Most commonly associated with URI, AOM, meningitis
Labyrinthitis
Acute onset of severe vertigo, nausea & vomiting, balance issues, tinnitus, unilateral hearing loss
Labyrinthitis
positive head thrust indicates?
Labyrinthitis
head thrust sign
can’t fix vision as head is moved
horizontal nystagmus
Labyrinthitis treatments (4)
Symptomatic- bed rest, hydration
Benzos
Anticholinergics (as an anti-emetic)- Prochlorperazine/Compazine
Antihistamines (as a vestibular suppressant similar to dramamine)- Neclizine/Antivert
amoxicillin dose
900 mg/kg BID
rhinorrhea, sneezing, itchy eyes, itchy nose, nasal congestion, PND, ~cough
Allergic rhinitis
What histories should be considered for allergic rhinitis? (4)
hx of hay fever, asthma, eczema, and allergies
On physical diagnosis: pale, “blue” mucosa, clear discharge; pale, swollen conjunctiva with some injection
Allergic rhinitis
External eye characteristics of allergic rhinitis
“allergic shiners” & Denie Morgan Lines
skin folds under eye consistent w/ allergic conjunctivitis
Denie Morgan Lines
First line drug treatment for allergic rhinitis
2nd gen topical intranasal corticosteroids
Fluticasone (Flonase), Triamcinolone (Nasacort)
1st gen topical intranasal steroids
and what they’re used for?
Beclomethasone (Beconase), Flunisolide (Nasolide)
alternative to 2nd gen for treatment of allergic rhinitis
Antihistamines for 2nd line allergic rhinitis (5)
Chlorpheniramine (Chlor-trimeton) or Diphenhydramine (Benadryl)
Loratadine (Claritin), Fexofedadine (Allegre), Cetirizine (Zyrtec)
Which symptoms of allergic rhinitis can be alleviated by antihistamines?
sneezing, rhinorrhea, itching
No congestion relief
allergic rhinitis treatment that vasoconstricts to decrease edema and secretions
Sympathomimetics (Decongestants)
Psuedoephedrine (Sudafed)
Psuedoephedrine (Sudafed) contraindications
HTN, heart disease
Last line, most intense allergic rhinitis treatment
Immunotherapy- “allergy shots”
allergy shot mechanism of treatment
increased production of specific IgG antibodies
nasal congestion, rhinorrhea
no itching, sneezing
normal nasal mucosa
normal IgE antibodies
Perennial Non-Allergic (Vasomotor) Rhinitis
Perennial Non-Allergic (Vasomotor) Rhinitis sxs
nasal congestion, rhinorrhea
no itching, sneezing
abnormal autonomic responsiveness triggered by stress, sexual arousal, perfumes, smoke, temperature change
Perennial Non-Allergic (Vasomotor) Rhinitis
Perennial Non-Allergic (Vasomotor) Rhinitis treatments (5)
Trigger avoidance, topical steroids***, topical antihistamines, topical anticholinergics, 1st gen oral antihistamined
Pedunculated, non-tender, grey, soft tissue growths
Nasal congestion/obstruction
Nasal polyps
Nasal polyp treatment
refer to ENT
rebound congestion following overuse of topical decongestants (afrin)
Rhinitis medicamentosa
Rhinitis medicamentosa physical exam findings
Erythematous nasal mucosa
Rhinitis medicamentosa treatment
discontinue medication (taper) and supplement with intranasal glucocorticoid
Tx for fungal otitis media?
Fungal: Clotrimazole (3 drops BID for 14 days), acetic acid irritation
Anticholinergics for labrynthitis
Anticholinergics (as an anti-emetic)- Prochlorperazine/Compazine
