Ear Infections and Allergic Rhinitis Flashcards
etiology of otitis externa
bacterial: gm - E. coli, pseudomonas aeruginosa, proteus vulgaris; gm + staph. aureas
fungal: Asperigillis or Candida albicans
Aka “swimmers ear” brought on by heat + moisture, may be secondary to trauma or associated with skin diseases.
presentation of otitis externa
external ear pain and tender tragus; pruritis; discharge (yellow =pseudomonas, green =staph, white/black “fluffy”=fungus); EAC erythematous, edematous; may have conductive hearing loss
Note if TM is intact or not
treatment of otitis externa
Bacterial: Cortisporin Otic Suspension (do NOT use if perforated TM), Ofloxacin Otic Solution (for perforated TM); 3-4 gtts QID, resolves in 5-7 days
Fungal: Clotrimazole 1% Solution 3 gtts BID x 14d
Prevention/Prophylaxis: keep canal dry, 2% Acetic Acid (VoSol) or 50/50 white vinegar/water solution
etiology of malignant otitis externa
Pseudomonas infection of ear with involvement of underlying bone.
diabetic and immunocompromized patients at higher risk
presentation of malignant otitis externa
fever, increasing ear pain; red, granulation tissue in EAC; discharge; ear/EAC erythematous, edematous; may have conductive hearing loss
watch for cranial nerve 7 & 8 involvement
treatment of malignant otitis externa
need to admit, IV antibiotics, and debride
etiology of acute otitis media
Strep. pneumoniae, H. flu; Moraxella catarrhalis;
many other bacteria & viruses
risk factors: children’s straight eustachian tube, enlarged adenoids; 2nd hand smoke; seasonal; day care
presentation of acute otitis media
irritability; decreased appetite; +/- fever; ear pain (tugging on ear); hearing loss; conjunctivitis; rhinorrhea; ear discharge; vomiting and diarrhea; erythematous TM with decreased mobility, loss of landmarks
treatment of acute otitis media
antibiotics:if less than 6 mo - antibiotics
If 6 mo to 2y - antibiotics if Dx is certain or illness is severe
if 2y - antibiotics if diagnosis is certain AND illness is severe; use augmentin or other if kids are high risk for amoxicillin resistant bacterial infection
care for pain/fever: acetaminophen, ibuprofen (esp if fever >101F)
fluids, decongestants (not antihistamines)
etiology & diagnosis of chronic otitis media
> 3 cases of acute otitis media in 6 months; or >4 cases in 12 months
may be brough on by trauma, cholesteatoma
pseudomonas, proteus, S. aureus, mixed
presentation of chronic otitis media
recurrant acute otitis media symptoms, TM perforaton w/purulent discharge; conductive hearing loss
treatment of chronic otitis media
refer to ENT, myringtomy
etiology of TM perforations
associated with acute/chronic otitis media; trauma
presentation of TM perforations
+/- pain; otorrhea (discharge/drainage); vertigo(indicative of inner ear injury); conductive hearing loss; no TM movement; visualize perforation
treatment of TM perforations
most heal spontaneously
etiology of mastoiditis
extension of otitis externa or acute otitis media to the mastoid process (suspect if these conditions are slow to resolve)
presentation of mastoiditis
mastoid tenderness, edema, erythema; deep temporal pain
treatment of mastoiditis
IV antibiotics, refer to ENT
etiology of serous otitis media
middle ear effusion secondary to inflammation/dysfunction of the eustachian tube; may be seen foling URI, acute otitis media, or with allergic rhinitis
presentation of serous otitis media
“ear fullness,” decreased or “tunnel” hearing; usually painless; amber colored fluid or bubbles behind immobile TM; retraction of TM; Tympanogram is type B
treatment of serous otitis media
topical nasal decongestants (to open eustachian tube, no more than 3 days)
antibiotics: amoxicillin, augmentin, bactrim
refer to ENT for persistant fluid and/or hearing loss, or if unilatera.
etiology of labyrinthitis
benign, acute inflammation/infection of the vestibular system; usually associated with viral infections
AKA “vestibular neuronitis”
presentation of labyrinthitis
acute onset of severe rotational vertigo, not related to head position; horizontal nystagmus; ataxia (unstable gait); nausea and vomiting
NO tinnitus, NO hearing loss
treatment of labyrinthitis
symptomatic:bedrest, hydration
benzodiazepines (Diazepam); anti-cholinergics (prochlorperazine); antihistamines
etiology of allergic rhinitis
hyper-responsiveness to allergen, increased production of IgE antibiodies leads to an inflammatory response
may be seasonal or perennial
presentation of allergic rhinitis
rhinorrhea, sneezing, itchy eyes, itchy nose, nasal congestion, clear post nasal drainage, cough, “allergic salute”; bluish mucosa w/ clear discharge on nasal speculum exam; swollen, red or pale conjunctiva; allergic shriners, Denie Morgan lines
diagnosis of allergic rhinitis
Skin tests (can produce false - & +): scratch and prick or "wheal-and-flare" Blood tests (non specific): IgE (not really useful) radioallergosorbent test(RAST)
treatment of allergic rhinitis
identify and avoid allergens; antihistamines (first generation - Benadryl is sedating); decongesttants(caution with HTN), topical corticosteroids (risk of growth hormone decrease in kids); immunotherapy (hyposensitization - last resort).
vasomotor rhinitis
abnormal autoimune responsiveness triggered by stress, arousal, perfumes, smoke, or anti-hypertension meds
AKA Perennial Non-Allergic Rhinitis
presentation of vasomotor rhinitis
nasal congestion, rhinorrhea
NO itching or sneezing; nasal mucosa appears normal
treatment of vasomotor rhinitis
avoid triggers; antihistamines; decongestants; topical anticholinergics (Atrovent)
background of nasal polyps
associated with ‘asthma triad’: asthma, nasal polyps, aspirin hypersensitivity
seen with allergic rhinitis and vasomotor rhinitis
presentation of nasal polyps
nasal conjestion; pedunculated, non tender, soft grey tissues growths in nose
treatment of nasal polyps
refer to ENT for surgery
etiology of rhinitis medicamentosa
tachyphylaxis/overuse of topical decongestants - if they stop the medication they get severe rebound congestion
presentation of rhinitis medicamentosa
rebound conngestion when topical decongestants are discontinued; erythematous mucosa
treatment of rhinitis medicamentosa
discontinue / taper off of topical decongestants (may use a nasal steroid to help with taper)
sypmtoms resolve 2-3 weeks after discontinuation
