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PEM RC Exam > Ear pain > Flashcards

Ear pain Flashcards

1
Q

What is the most common cause of ear pain in kids?

A

AOM

Other DDx
Otitis externa
FB
Dental caries or abscess
Pharyngitis
Cervical lymphadenitis
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2
Q

What are the diagnostic criteria for AOM?

A

1) Recent, usually abrupt onset of signs and symptoms of middle ear infection (pain, irritability, fever, otorrhea)
2) Presence of middle ear effusion
3) Signs of middle ear inflammation (ear pain, bulging or redness of TM with impaired motility)

Other signs of AOM:

  • Hearing loss
  • Vertigo
  • Tinnitus
  • Postauricular swelling
  • Facial paralysis
  • Conjunctivitis
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3
Q

What bug causes otitis-conjunctivitis syndrome?

A

H. flu

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4
Q

What are the most common bacterial pathogens that cause AOM?

A

Strep pneumonia
Nontypable H flu
Moraxella catarrhalis

Occasionally:

  • Strep pyogenes
  • Staph Aureus
  • Mycoplasma
  • Gram neg bacilli
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5
Q

Describe the management of AOM

A

If patient < 6 months - TREAT
If > 6 months can:
- Watch and wait for 1st 48h of Sx
- Manage with analgesia - usually q6h Advil and Tylenol as breakthrough
- If Sx > 48-72h or no relief from above - Tx with Abx

1st line: Amoxicillin 40-60 mg/kg/day div TID
OR 80-90 mg/kg/day div BID
2nd line: Amox-Clav

5 days for > 2 years
10 days for < 2 years

If Type 1 penicillin allergy - Azithromycin, Clarithro, Septra
If not Type 1 penicillin allergy - Cefuroxime, Clinda

If noncompliant or not tolerating PO:
Ceftriaxone 50mg/kg IV x 1
Can get a second dose in 48h

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6
Q

What is otitis media with effusion?

A

Collection of fluid in the middle ear without signs and symptoms of acute infection
Bulging TM, limited or absent motility with pneumatic otoscopy, A/F level behind the TM, or otorrhea

Tx - Abx x 10 days with anti-Beta-lactamase activity
No resolution - refer to ENT for tubes

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7
Q

What bugs has vaccines reduced the incidence of in terms of AOM?

A 
Strep pneumo (pneumococcal conjugate)
Influenza (influenza vaccine)
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8
Q

How many months of prophylaxis is needed to prevent AOM?

A

9 months to prevent a single episode of AOM

Not practical - not recommended

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9
Q

Indications for tubes

A

Associated hearing loss

Risk of developmental loss or failure to progress

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10
Q

Name the complications of AOM

A 
Perforation of the TM
Cholesteatoma
Adhesive OM
Tympanosclerosis
Mastoiditis
Petrositis
Labrynthitis
Meningitis
Facial paralysis
Suppurative complications of the brain
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11
Q

What is bullous myringitis?

A

Infection of the TM with intensely painful bulla formation on the surface
Dx by otoscopy
Pathogen - usually viral or Strep pneumoniae
Same Tx as regular AOM

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12
Q

What is otitis externa?

A

Inflammatory process affecting the external auditory canal
Often present with pain after a few days of external pruritis
Common in the summer
Pain when pushing on the tragus or traction of the pinna or moving the jaw from side to side

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13
Q

What are the RF for otitis externa?

A

Summer months
Pool exposure
Obstructive cerumen
Long tortuous canal
Loss of acidic environment due to inadequate cerumen lavage
Exposure to an alkaline substance
Interruption of the epithelial lining due to trauma or dermatitis

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14
Q

What are the most caustive organisms for otitis externa?

A

Pseudomonas
Staph
Strep
Proteus with pseudomonas

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15
Q

Treatment for otitis externa

A

Avoidance of swimming
Pain control
Ear drops from steroid/Abx combo - Ciprodex

If severe edema of the canal - can place a wick
If severe infection - may need PO Abx

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16
Q

What is malignant otitis externa?

A

Severe form of otitis externa that is not responsive to conventional therapy
Caused by Pseudomonas
Involves the bone and marrow of the skull base - causing osteomyelitis
Complications: chondritis, facial paralysis, stenosis of the canal and permanent hearing loss
More common in diabetes mellitus or immunocompromised patients
Need CT or nuclear imaging to help Dx
Tx - IV Abx and removal of granulation tissue

17
Q

What is bruising to the internal surface of the pinna or hemotympanum concerning for?

A

Child abuse

Only results from direct blow to the ear

18
Q

What types of infection can result from ear piercing, bugs and Tx

A

Cellulitis or perichondritis
Bugs: Staph and Pseudomonas
Tx - remove the piercing, I&D abscess, IV antibiotics if cartilage is infected

19
Q

What are the features of mastoiditis

A 
Fever
Ear pain
Red swollen ear
Protruding from the side of the head
Erythematous and tender posterior auricular area
Must have erythematous TM

Can be confused with otitis externa - TM would be normal in this case

CT can help confirm Dx

20
Q

What is petrositis?

A

Infection of the petrous part of the temporal bone

21
Q

What is the triad for Gradenigo syndrome?

A

Deep facial pain
Otitis media
Ipsilateral abducens nerve paralysis (CN6) - cannot perform lateral gaze

22
Q

How is mastoiditis treated?

A

Admit
IV Abx - cover Staph, Strep, H influenza
(Cefotaxime, Clindamycin, Vancomycin)
Complicated infection or abscess may need mastoidectomy

23
Q

What are the potential complications of mastoiditis?

A

Intratemporal OR Intracranial

INTRATEMPORAL
Facial paralysis
Labyrinthitis
Petrositis

INTRACRANIAL
Meningitis
Lateral sinus thrombosis
Epidural, subdural or brain abscess

24
Q

Methods for removing a FB from the external canal

A 
Alligator forceps
Curettes
Right-angle hooks
Baron suction devices
Elephant ear irrigation with warm water
Dermabond on stick
Fogerty catheter
25
Q

What is the most worrisome FB in the external canal?

A

Hearing aid battery

Call ENT

26
Q

How to settle down an insect in the ear?

A

Pour immersion oil, mineral oil, 1% or 2% lidocaine or viscous lidocaine in the ear
This will paralyze the bug and relieve the pain
Then remove the bug with a curette or flushing after

27
Q

What is middle ear barotrauma?

A

Injury to the TM from a sudden change in pressure due to diving, flying or blast injuries
Can cause severe ear pain
TM appears swollen and blue
Refer to ENT if patient has dizziness or hearing loss - worry about a perilymphatic fistula

28
Q

Name causes of non-otogenic otalgia

A

Otalgia can be referred pain from distant sites secondary to inflammatory processes, tumors or trauma

Dental issues (from CN 5,6,9,10 and cervical nerves C2/C3)
These nerves supply the nasal sinus area, oral cavity and teeth, oropharynx, hypopharynx, larynx, and upper esophagus

TMJ Joint dysfunction
Can also be psychogenic

29
Q

Name the nerve that carries the sensation of non-otogenic otalgia

A

CN5
- Disturbances in the oral cavity including stomatitis, gingivitis, lymphadenitis, parotiditis, trauma, tongue infections, dental conditions (eruption, impaction, trauma, caries, infection, abscess)

CN6
- Bell’s palsy, herpes zoster, tumors

CN9
- Tonsillitis, retropharyngeal abscess, adenotonsillectomy, nasopharyngeal or oropharyngeal tumors

CN10

  • lesions of the base of the tongue, trachea, larynx, and esophagus
  • GERD

UPPER CERVICAL NERVES (C2/C3)
- Cspine injuries, arthritis, disc disease

30
Q

What is Ramsay-Hunt Syndrome?

A

Herpes zoster otitis OR Viral polycranial neuropathy affecting the ear

31
Q

What are the Sx of Ramsay-Hunt Syndrome?

A 
Severe otalgia
Facial palsy
Vesicles on the pinna, external auditory canal, and TM
All CN can be affected
Hearing loss
Vertigo
N/V
Dizziness
32
Q

How do you Tx Ramsay-Hunt Syndrome?

A

Acyclovir PO
Systemic steroids
Analgesia

33
Q

How to confirm that TMJ dysfunction is the cause of referred otalgia

A

Carefully palpate the TMJ externally by placing the fingers just anterior to the tragus and having the patient open and close the mouth
Positive test - patient reports otalgia during attempted occlusion

Pain can be caused by nerve irritation, muscle spasm, or degenerative changes in the joint

RF

  • clenching teeth
  • bruxism
  • gum chewing
  • malocclusion

Tx

  • heat therapy
  • soft diet
  • analgesia
  • physiotherapy
  • oclusal splints
  • rarely surgery

PEM RC Exam (25 decks)

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