Ear Problems Flashcards
What are symptoms of Ear Infections?
- Pain inside the ear
- High temperature >38
- Being sick
- Lack of energy
- Difficulty hearing
- Discharge running through the ear
- Feeling of pressure or fullness inside the ear
- Itching and irritation in and around the ear
- Scaly skin in and around the ear
What are symptoms specific to young children and babies with ear infections?
- Rub or pull their ear
- No reaction to some sounds
- Be irritable or restless, off their food
- Keep losing their balance
What are red flag symptoms of Ear Infections?
- Very high temperature or feel hot and shivery
- Earache that doesn’t start to get better after 3 days
- Swelling around the ear
- Fluid coming from the ear
- Hearing loss or a change in hearing
- Other symptoms, like being sick, a severe sore throat or dizziness
- Regular ear infections
- Long-term medical condition – such as diabetes, or a heart, lung, kidney or neurological disease
- Weakened immune system – because of chemotherapy, for example
How is Acute Otitis Externa treated?
- Treat pain with analgesia
- Treat infection with oral antibiotics if the infection is severe such as cellulitis or systemic signs of infections such as fever although its rarely indicated:
- 7-day course of flucloxacillin or clarithromycin
- Drain pus if necessary such causing severe pain
How is Acute Otitis Media treated?
- Advise can last for 3 – 7 days and regular doses of paracetamol or ibuprofen for pain
- Offer antibiotic if severe or a backup antibiotic.
- Amoxicillin for 5-7 days for 500mg every 8 hours.
- Offer Co-amoxiclav if the 1st line antibiotic doesn’t work.
- If the symptoms still persist, refer to microbiology or ENT.
- Reassess if symptoms worsen rapidly
When are patients with Acute Otitis Media admitted?
Admit if a severe systemic infection, if you suspect complications such as meningitis, mastoiditis, intracranial abscess, sinus thrombosis, or facial nerve paralysis or if it is a child younger than 3 months of age with temperature of 38 degrees or more
How are patients with Recurrent Otitis Media managed?
Refer urgently to ENT specialist if nasopharyngeal cancer is suspected in presence of:
- Persistent symptoms and signs of otitis media with effusion between episodes due to obstruction of the eustachian tube
- Persistent cervical lymphadenopathy
- Epistaxis and nasal obstruction
Refer to ENT if person has craniofacial abnormality
How is Acute Otitis Media with effusion treated?
- Acute observation over 6-12 weeks is appropriate for most children as spontaneous resolution is common
- Re-evaluate signs and symptoms of the effusion and concerns regarding the child’s hearing or language development to look for any complications as this determine whether it is appropriate to continue with active observation or refer child to ENT specialist
- Do 2 hearing test using pure tone audiometry at least for 3 months Antibiotic, Antihistamine, Mucolytics, Decongestants, Corticosteroids are not recommended
What is the non-surgical treatment options if a patient is referred for Acute Otitis media with effusion?
- Observed for a period of 3 months
- Hearing aids can be given as a non-surgical alternative
- Auto inflation by nasal balloon involves blowing up a balloon via the nostril two to three times a day, thus ventilating the middle ear, equilibrating pressure, and allowing some drainage of fluid. But not used for children with an upper respiratory infection
What is the surgical treatment options if a patient is referred for Acute Otitis media with effusion?
- Should be offered as an alternative to hearing aid with in children with cleft palate who have OME and persistent hearing loss.
- Factors should be considered beforehand in children with Down’s syndrome such as:
- Severity of hearing loss
- Age of the child
- Practicality of grommet insertion
- Associated risk and likelihood of early extrusion of grommet.
- Adjuvant adenectomy shouldn’t be offered in absence of persistent and/or frequent respiratory tract infections
How are patients with grommets inserted assessed?
- Follow-up periodically and their hearing should be re-asse
- Advise parents that grommets cause few problems and work their way-out of the ear, normal school activities should be encouraged, holiday activities should not cause problems, swimming should be discouraged but increased infection risk.
What are the complication of Grommets?
- Otorrhea
- Infection
- Tympanosclerosis
- Perforation of the tympanic membrane
- Fibrosis
What is the parental advice for Acute otitis media?
- Smoking increases risk of otitis media with effusion
- When speaking to child, face them, slow the rate of speech, raise level of speech and speak clearly.
- Turn off competing auditory stimuli such as music or television.
- Daily reading helps language development and place child in front in school
What are symptoms of BPPV?
- Generally rotational but sometimes sufferers, on lying down, will feel that they are falling through the bottom of the bed or, on getting up, that they are thrown back onto it.
- Provoking movement to induce BPPV are: lying flat, sitting up from lying flat, turning over in bed, looking up or bending down especially if also looking to the side
- Usually last 5 to 30 seconds
What is the causes of BPPV?
- Loose chalk crystals get into the wrong part of the inner ear. Crystals should be embedded in a lump of jelly. Crystals weigh jelly down and make that part of the ear sensitive to gravity
- Lying flat can then occasionally cause of the loose debris to fall into one of the semicircular canals which is responsible for sensing rotation.
- Movement in the plane of the affected canal causes the crystals to move along the canal, stimulating it and giving the sensation of rotation
