Ear infections x2 Flashcards
Otitis Externa cause
swimmers ear
- trauma or associated skin disease
- Bacterial* most common*: pseudomona, staph
- Fungal
Otitis Externa Presentation
Otalgia- push on tragus/ pull on pina pruritis discharge - green: pseudomonas -yellow- staoh - fungal: flffy, white, or black -erythema and edema of canal and possiby decreased hearing
Otitis externa Managment
- clean ear canal
- treat infection and inflammation
- contol pain NSIADs
- keep canal dry: no swimming and cotton in ear during bathing
Otitis externa bactral managment
Cotisporin Otic - supsension or solution - DO NOT use if TM is perforatied Floxin Otic -solution - indicated if TM is perforated Ciprodexor CiproHC - suspension - better for relief of edema and inflamation
Ottis Externa fungal
Fungal injections
- Metifculus cleaning and Clotirimazole 1% BID x10-14days
- then acidifying solutions
Prevention of ottis Externa
Acidifying solution in the ear
- drying the EAC
- if recurrent add bathing cap or ear plugs
With treatment it should reslve 5-7 days
Malignant Otitis externa cause
- when infection spreads from EAC to temporal bone
Risk: elderly DM
cause: pseudomonas
Malignant otitis ext presentation presentation
granulation tissue: pink shiny tissue.
Exquisite otalgia and not responsive to treatment
- pain is worse at night and when they chew**
may have trismus, lymphademopathy, edema
- watch for CN involment
Malignant otitis Dx
^ ESR CRP (infm markers)
CT scan- show osteomyalitits and bone distruction
MRI: to check for the extent of the disease spread
Malignant otitis Tx /comp
Admit to hospital and C&S ear discharge
- conduct culture and then provide antibiotic
- being with ciprofloxican
- change to oral when imrpoves
Comp: intracranial sprea
Otitis Media types
- Otitis media with infusion
- no pus - Acute otitis media
- will have pus - Chronic aotitis media
- always have TM that isnt intact
Otitis Media with Effusion (OME )
Etiology: reacent AOM
Middle ear fluid without signs of ilness or inflamation> ear fullness and decreased hearing usually painless
- can see air bubles
- neutral or retracted TM
- conductive hearing loss
- TM will not move with pneumatic otoscopy
*tympanogram Type B pattern
OME managment
- ” watchful waiting”
-possible T tibe palcement
Refer: if longer than 3 months or at risk children
Eustachian tube disfunction
Ondstuctive disfunction is most common> resulting in negative ear pressure
Sx: ear fullness, recurrent OME, hearing loss
Dx; retracted TM- prominant boney landmarks
Tympanogram type C
Eustachian tube dis Tx
ACUTE otitis media
purulent fluid, reddness, mastoid air cells are involved
peds: irritability, poor feeding, fever, ear paintugging on their ear. - may also see conjunctivitis, rihnorea, discharge.
Adults: otalgia and decreased hearing rarely a fever
Acute otitis media risk
little kids 6-18 month old ( 2nd smoke, no breast feeding, use of pacifier, season)
- precipated by viral URI
- eustanchian tube becoms obstructed
Path: strep, haemophilus influenzarr, and moraxella catarrhalis
AOM exam present
Bulging Tm- loss of landmarks and light reflex in dampended
erythema of TM
porr mobility- pneumatic otoscopy
Bullous Myringitits
bulla forming
- from virus
- treat like AOM
Diagnosis of AOM
6-12 mon
- buldign of TM, otorrhea not due to acute OE
- mild buldging and ear poin/ erythmea of TM
AOM whether to treat
<6mo treat with abx all children : - mod severe otalgia - more than 48hrs -temo > 102.2 <24 months old bilietral
can chose if 6-23mon unilateral non severe, >24mon unilateral or bilateral non svere
** need close followup**
AOM tx
- Amoxixillin unless
- 30 days, concurrent conjunctivitis, hx of recurrent AOm, if allergic to PCN
^ dose 90mg/kg/day every 12 hrs for 7-10 days
2nd line:
2. amoxicillin/clavulate(augmentin)
- 90mg/kg and 6.4 mg/kg clavulanate
3. if pcn allergy
- oral: cefalosporins
- if serois PCN reaction: azithromycin, clarithromycin clindamycins
Symptomatic relief: hydration and pain/fever managment. avoid cough and cold mediciens
recurrent AOM
develop withing 30 days after sucsessful tx <15 tx cetriaxion >15days with augmentin consid T tubes > 3epidsone in 6 months >4 epi on 12 months
Complications of AOM
conductive hearing loss TM perforation chronic otitis media typanosclerosis cholesteatoma mastoiditis acute labryrinthitis
Tympanometry
quantitative measure of TM mobility
- done by ENT of audiology
A- normal
B- little or no mobility usually becuase of fluid or TM perforation
C: retracted- starting at neg point - eustacian tube disfunction
TM perforations
+/- pain
conductive hearing loss
no movement with pneumatic otoscopy
- vertigo means issue with inner ear
Chronic otitis media
drainage from the middle ear > 2wkes and assocaited with TM perforation that is painless
-etiology: recurrent AOM, pseudomona, MRSA, conductive ear loss
Tx: refer to ENT
Cholesteatoma
abnormal growth of squamous epithelium in middle ear/ astoid
- caused by recurrent AOM
- they can progressively large and destroy the ossicles
Mastoiditis
Post auricular pain edeme and erythema> complication of AOM - flucutance or mass - fever - temporal pain - protrusion of penna Tx: IV antibiotics and ENT consults
Labyrinthitis
Benign self limiting disorder of vestiular system
- unilateral hearing loss is present
* though to be becuae of virus*
Prsent: acute onset, N/V, sudden vertigo, may have nystagmus
+head thrust
- no CNS deficits ( differnt from stroke!)
Tx: symptomatic treatment
- rest, hydration, 1 gen antihistamine (meclizine)
-antiemetics- prochlorperazine
