Ears Flashcards
Hearing Screening
Universal detection of hearing loss by 1 month
Follow up with abnormal NB screening by 3 months
AAP Bright futures: pure-tone audiometry at 3, 4, 5, 6, 8, 10, 12, 15, 18 years
NBS: draw at 24-48 hours
- Rpt by 1 month
- Dx by 3 months
- Tx by 4 months
Hearing Loss (Conductive and Sensorineural)
Conductive (most common): Congenital or acquired; problem in outer or middle ear; blocked transmission of soundwaves (OME, wax, foreign body)
Sensorineural: Dysfunction for damage to cochlea or auditory nerve (causes: TORCHES, prematurity, med exposure, inherited)
Etiology: Genetic or hereditary, environmental or acquired diseases, malformations, trauma, ototoxicity, unknown
Tx: refer for audiological testing, surgery for conductive hearing loss or sensorineural hearing loss
Complications: speech and language disorders
Otitis Externa
Etiology: bacteria (s. aureus), fungi, excess or loss of cerumen, trauma to ear canal, allergic reactions, excessive wetness or dryness, purulent OM with perforation of the TM
S/Sx: ear pain and itching, feeling of fullness or obstruction, history of exposure to water; pain upon movement of pinna or tragus
Tx: clean debri from canal, topical treatment, oral antibiotics
F/U: Mild cases, immediate recheck (return visit in 2 to 3 days), telephone (recheck in 10 days)
Prevention: avoid water in ear canals, well-fitting earplugs for swimmers, alcohol/vinegar/distilled water otic mix (2:1:1) after swimming
Foreign Body
Most common between 2 to 4 years
Treatment: remove foreign body, kill insects, referral conditions
Complications: perforation of TM
Acute Otitis Media (AOM)
Cause: strep pneumoniae, Hib, strep pyogenes, s. aureus, psuedomonas
Occurrence: after URI, increased since 1985, racial differences, factors that increase incidence
Clinical Manifestations: fever, ear pulling/pain, irritability
AAP Guidelines for Diagnosis of AOM:
- AAP guidelines for dx: (presence of 3)
- Recent, abrupt onset of middle ear inflammation or effusion
- Middle ear effusion confirmed by bulging TM, limited/absent mobility by pneumatic otoscopy, air-filled level behind TM, otorrhea
- S/sx of inflammation (distinct erythema of TM, pain)
AOM Physical Findings and Diagnosis
Physical Findings: fever, signs of URI or allergies, enlarged cervical nodes, otoscopic findings
Dx: pneumatic otoscopy, tympanometry, acoustic reflectometry, tympanocentesis
AOM Treatment
TREATMENT
Pain
- Ibuprofen or acetaminophen (give correct doses)
- Topical analgesics if TM intact
Antibiotics
- Amoxicillin (80-90 mg/kg/day) divided twice daily - first line if no AOM in past 30 days and no PCN allergy
- Ceftriaxone (Rocephin) in vomiting child
- Clindamycin for ceftriaxone failure
Follow-up: 48-72 hours if no improvement, once abx complete
Pressure-Equalizing Tubes (PE Tubes)
Clinical practice guidelines: Refer if recurrent AOM 3 times/6 months or 4 times/year
Placed under general anesthesia
No precautions when bathing, showering, or surface swimming
Earplugs if diving or dunking
Otitis Media with Effusion (OME)
Etiology: same as AOM; Hib frequency greater in OME
S/Sx: Maybe asymptomatic; complaints of hearing loss, possible language delay, irritability
PE: Possible indicators of allergies, possible enlarged tonsils, possible cervical lymphadenopathy, TM, pneumatic otoscopy, decreased mobility of TM, interference with sound conduction
Dx: pneumatic otoscopy, tympanometry, audiometry
Tx: most resolve in 3 months, document conditions at each visit, distinguish at-risk child, refer for hearing evaluation for OME cases > 3 months
Follow-up: return visit in 1 month, sooner if acute symptoms develop
Cholesteatoma
Result of chronic ear infection - formation of epidermal inclusion cyst of middle ear/mastoid
Clinical findings: infection, hearing loss, dizziness, facial muscle paralysis, pearly white lesion on or behind TM
Management: ENT referral
Eustachian Tube Dysfunction
Causes: URI, pressure changes, OM, GERD, enlarged adenoids, allergies, Down syndrome
Occurrence: most common in children < 5 years
PE: Retracted TM, effusion, decreased movement on pneumoscopy, nasal obstruction, tuning fork test
Dx: usually none
Tx: decongestants, nasal steroids, second-generation H1 antihistamines, antibiotics, tympanic perforation or ventilation tubes present, pain management
Follow-up: check tubes every 3 months; check for OME resolution; return visit
Complications: TM perforation, hearing loss, meningitis, brain abscess, Subdural empyema, cholesteatoma labyrinthitis, subperiosteal abscess, facial paralysis, death
