Ears 1 Flashcards
Tx for AOM w/ perforated TM
Amoxicillin (oral), plus topical abx with low ototoxicity such as ofloxacin or fluoroquinolone and analgesics (pain killers)
–DO NOT USE aminoglycosides
- Spiking fevers
- Postauricular pain
- Postauricular erythema
Mastoiditis
Sensorineural loss:
where does sound lateralize to w/ Weber test?
AC > BC
-to good ear
The 3 urgent FB of the ear
- button batteries
- live insects
- penetrating FB
5 complications of AOM
- Labyrinthitis
- Hearing loss
- Mastoiditis
- Non-responsive to meds
- Recurrent infections
How soon should AOM improve after starting tx with abx?
2 - 3 days
PE findings w/ AOM
- Immobile TM
- Erythema
- Bulging
- can possibly be ruptured
- Retracted
- Bullae
Osteomyelitis of temporal bone/skull base, tx?
Malignant otitis externa (necrotizing otitis externa) = FATAL, give IV abx (quinolones) for a few months or surgery
- family hx
- daycare
- lack of breastfeeding
- 2nd hand smoke/air pollution
- pacifier use
risk factors of AOM
1st line tx for AOM
high dose Amoxicillin (80 to 90 mg/kg/day twice daily)
- Foul smelling discharge
- Granulations in ear canal
- Deep otalgia
- CN palsies
- HA
Malignant OE (necrotizing otitis externa)
Ototoxicity is associated with which med?
Aminoglycosides (topical ear drop)
Conductive hearing loss, with the Rinne test is AC or BC greater with the good ear?
AC > BC
- Decreased hearing
- Otalgia
- Drainage
- Chronic cough/hiccups
Foreign body in ear
Is more common w/ bacterial infections of otitis externa
Purulent discharge
2nd line tx for AOM
high dose Amoxicillin-clavulanate or 2nd/3rd generation cephalosporin
Epidemiology of AOM. Which age group is most common? Which seasons most common?
4 to 24 months old
-fall and winter
What causes AOM?
Bacterial infection of middle ear, usually preceeded by URI
What rare ear condition would we tx with antivirals instead of abx?
Ramsay Hunt Syndrome (Herpes Zoster Oticus), vesicles on outer ear canal
5 differential diagnosis for OE
- Middle ear disease
- Contact dermatitis
- Psoriasis
- Chronic Suppurative OM
- Squamous cell carcinoma of external canal
3 main complications of OE
- Periauricular cellulitis
- Contact dermatitis
- Malignant otitis externa (necrotizing otitis externa)
Tx for otitis externa if TM is intact
Topical ear drops (aminoglycosides or fluoroquinolone with or without corticosteroids)
Is more common w/ fungal infections of otitis externa
Pruritis and black discharge
Which ear conditions need referral to ENT?
- persistent otitis externa
- immunocompromised/DM patients
1st, 2nd, and 3rd most common bacteria which cause AOM?
- -Strep pneumoniae
- -Haemophilus influenza
- -Moraxella catarrhalis
3 reasons poor drainage of eustachian tubes?
- age
- inflammation/edema
- congenital malformation
- Otalgia
- Pruritis
- Purulent discharge
- hearing loss
- fullness
- hx water exposure or trauma
Otitis externa
Abnormal Rinne test
BC > AC
Cauliflower ear from hematoma not being drained will lead to the ear being disfigured. What else is impacted?
Hearing
Why does bacteria build up with AOM?
Obstructed eustachian tube, so fluid/mucous accumulate and get secondarily infected
3 etiologies of otitis externa. Which is most common?
- Allergic
- Dermatologic condition (psoriasis)
- Infection (Pseudomonas (38%)
- Gram - rod
When would immediate abx for AOM be appropriate?
- < 6 months
- -or children < 24 months if sxs are severe (moderate - severe pain, pain over 48 hours, temp 102.2F, bilateral AOM)
Most common neoplasm of ear canal (cancer), it mimics chronic infection
Squamous cell carcinoma of external canal
Pathophysiology of most cerumen impaction
Self induced (Q-tips)
3 treatments for cerumen impaction
- Detergent ear drops
- Mechanical removal (curet)
- Irrigation w/ body temp water and TM intact, then dry it
Tx for otitis externa if TM is not intact or if pt has ear tubes
Fluoroquinolone
How would you remove an organic FB from ear? (beans, peas, insects)
DO NOT irrigate (it will expand)
-Use lidocaine to paralyze insect
Conductive loss:
where does sound lateralize to w/ Weber test?
BC > AC
-to bad ear
How do you tell if you’re looking at a right or left TM?
Cone of light points anteriorly
How many days do you tx otitis externa with meds?
7 - 10 days
Inflammation of semicircular canals
Labyrinthitis
Tx for recurrent infections of AOM
Tympanostomy tubes or (PE-pressure equalizing tubes)
Who is at higher risk for developing malignant otitis externa from an OE?
- DM patients
- immunocompromised
- Occlusive devices
- trauma
- debris from psoriasis
- swimming
- warm/humid climates
Risk factors for otitis externa
Normal Rinne test
AC > BC
Recurrent cases of AOM are associated with which 2 things?
- allergies
- 2nd hand smoke
What types of FB are removed with loop, hook, or irrigation
Firm objects (not organic)
How do you prevent AOM?
-Vaccinations
Tx for mastoiditis
IV abx or mastoidectomy
Associated w/ mycoplasma infection
Bullae
5 differential diagnosis of AOM
- OM w/ effusion
- OE
- ETD (eustachian tube dysfunction)
- Herpes Zoster
- Head/neck infection
Associated w/ wrestlers
Traumatic auricular hematoma (can lead to cauliflower ear if not drained)
- Otalgia
- Pressure
- fever
- URI sxs
Clinical presentation of AOM
How is Malignant OE diagnosed?
CT scan showing osseous erosion
PE findings w/ otitis externa
- erythema and edema of ear canal skin
- purulent drainage
- tenderness w/ tragal or auricle manipulation
- red TM (maybe)
- TM is mobile w/ pneumatic otoscopy
- TM may not be visible due to edema of canal
Which ear conditions need oral abx?
- Severe OM w/ cellulitis of periauricular tissue
- Recalcitrant cases
When would observation be appropriate for AOM?
Observe for 48 to 72 hours in children –6 mo - 2 yrs w/ unilateral and mild sxs
–2 yrs or older w/ unilateral or bilateral if not severe
What tx option is used if there is too much swelling of the canal restricting drops from entering ear?
Ear wick, keeps canal open. Is replaced every day or 2
- Hearing loss
- Fullness
- Itchiness
- Reflex cough
- Dizziness
- Tinnitus
Cerumen impaction
