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Clin Med I > Ear infections x2 > Flashcards

Ear infections x2 Flashcards

1
Q

Otitis Externa cause

A

swimmers ear

  • trauma or associated skin disease
  • Bacterial* most common*: pseudomona, staph
  • Fungal
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2
Q

Otitis Externa Presentation

A 
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
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3
Q

Otitis externa Managment

A
  • clean ear canal
  • treat infection and inflammation
  • contol pain NSIADs
  • keep canal dry: no swimming and cotton in ear during bathing
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4
Q

Otitis externa bactral managment

A 
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
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5
Q

Ottis Externa fungal

A

Fungal injections

  • Metifculus cleaning and Clotirimazole 1% BID x10-14days
  • then acidifying solutions
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6
Q

Prevention of ottis Externa

A

Acidifying solution in the ear
- drying the EAC
- if recurrent add bathing cap or ear plugs
With treatment it should reslve 5-7 days

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7
Q

Malignant Otitis externa cause

A
  • when infection spreads from EAC to temporal bone
    Risk: elderly DM
    cause: pseudomonas
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8
Q

Malignant otitis ext presentation presentation

A

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

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9
Q

Malignant otitis Dx

A

^ ESR CRP (infm markers)
CT scan- show osteomyalitits and bone distruction
MRI: to check for the extent of the disease spread

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10
Q

Malignant otitis Tx /comp

A

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

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11
Q

Otitis Media types

A
  1. Otitis media with infusion
    - no pus
  2. Acute otitis media
    - will have pus
  3. Chronic aotitis media
    - always have TM that isnt intact
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12
Q

Otitis Media with Effusion (OME )

A

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

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13
Q

OME managment

A
  • ” watchful waiting”
    -possible T tibe palcement
    Refer: if longer than 3 months or at risk children
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14
Q

Eustachian tube disfunction

A

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

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15
Q

Eustachian tube dis Tx

A
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16
Q

ACUTE otitis media

A

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

17
Q

Acute otitis media risk

A

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

18
Q

AOM exam present

A

Bulging Tm- loss of landmarks and light reflex in dampended
erythema of TM
porr mobility- pneumatic otoscopy

19
Q

Bullous Myringitits

A

bulla forming

  • from virus
  • treat like AOM
20
Q

Diagnosis of AOM

A

6-12 mon

  • buldign of TM, otorrhea not due to acute OE
  • mild buldging and ear poin/ erythmea of TM
21
Q

AOM whether to treat

A 
<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**

22
Q

AOM tx

A
  1. 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

23
Q

recurrent AOM

A 
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
24
Q

Complications of AOM

A 
conductive hearing loss
TM perforation
chronic otitis media 
typanosclerosis
cholesteatoma
mastoiditis 
acute labryrinthitis
25
Q

Tympanometry

A

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

26
Q

TM perforations

A

+/- pain
conductive hearing loss
no movement with pneumatic otoscopy
- vertigo means issue with inner ear

27
Q

Chronic otitis media

A

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

28
Q

Cholesteatoma

A

abnormal growth of squamous epithelium in middle ear/ astoid

  • caused by recurrent AOM
  • they can progressively large and destroy the ossicles
29
Q

Mastoiditis

A 
Post auricular pain edeme and erythema> complication of AOM  
- flucutance or mass 
- fever 
- temporal pain 
- protrusion of penna
Tx: IV antibiotics and ENT consults
30
Q

Labyrinthitis

A

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

Clin Med I (14 decks)

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