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Clin Med 1B Exam 2 > EENT treatments > Flashcards

EENT treatments Flashcards

1
Q

Acute Otitis Externa-Diffuse

A

Ofloxacin (Floxin) otic soln or Ciprofloxacin

Cortisporin Otic soln or susp (Neomycin, Polymyxin B, Hydrocortisone)

Cipro HC or CiproDex otic soln

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2
Q

Acute Otitis Externa-Furunculosis

A

Oral Dicloxacillin or Cephalexin (Keflex)

I&D if needed

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3
Q

Otomycosis

A

Cleaning of canal
Cotrimazole 1% solution BID 10-14 days

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4
Q

Chronic Otitis Externa-Non infective

A

Topical Hydrocortisone cream/otic drops

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5
Q

Chronic Otitis Externa- Malignant/ Necrotizing

A

Aggressive glycemic control

IV and oral Antibiotics 6 - 8 weeks typically required

Antipseudomonal antibiotics: ciprofloxacin, penicillin, or cephalosporin
Ciprofloxacin 200-400mg BID 1st line
Piperacillin, Cefepime (Maxipime)

Treat until clinical improvement seen

Selected patients may be graduated to oral ciprofloxacin

Aminoglycoside or Fluoroquinolone
Ciprofloxacin 500 - 1000 mg BID
Treat until gallium (nuclear) scan is clear of inflammation (generally 6-8 weeks)

Surgical debridement
In severe, refractory cases only, not usually needed

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6
Q

Chronic Otitis Externa- Malignant/Necrotizing

A

Ciprofloxacin 200-400mg BID 1st line

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7
Q

Chronic Otitis Externa - Herpes Zoster Oticus

A

Steroids and antivirals
Prednisone and Famciclovir (Famvir) or Valacyclovir (Valtrex)

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8
Q

Auricle Hematoma

A

Within 7 days, otherwise refer
Prevents significant cosmetic deformity
Lidocaine 1%: auricle block
I&D
Irrigate pocket with NS
Compression dressing
Leave on for 7 days
Re-examine for recurrence every 24 hours for several days
Avoid NSAIDS
Antibiotic prophylaxis +/-

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9
Q

Perichondritis

A

Want to start within 5 days
Risks hospitalization and deformity
Oral or IV Ciprofloxacin

I&D

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10
Q

Acute Otitis Media

A

Initial therapy
Amoxicillin 875mg BID
Cefdinir (Omnicef) 300mg BID
Cefuroxime (Ceftin) 500mg BID
Azithromycin (Zithromax) 500 PO Day 1, then 250 QD PO on Days 2-5
Lack activity against most H. flu and ⅓ of pneumococcal isolates

If exposure to antibiotics within 30 days or recent treatment failure after 72 hours
Amoxicillin plus Clavulanate 875mg (Augmentin ES or XR) PO in divided doses BID,
Cefdinir (Omnicef) 300mg BID
Ceftriaxone (Rocephin) 1g-2g IM daily for 3 days, OR
Clindamycin 30-40 mg/kg/d PO in divided doses TID

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11
Q

Acute Otitis Media-Severe

A

IF Significant hearing loss, severe pain, fever > 102⁰F, immunocompromised, under 6 months of age and or marked TM erythema

Initial therapy or with associated bacterial conjunctivitis (Likely H. Influenza)
Augmentin ES, OR
Ceftriaxone (Rocephin)
If exposure to antibiotics within 30 days or recent treatment failure
Ceftriaxone (Rocephin), OR
Clindamycin, OR
Consider tympanocentesis
Duration of all pharmacotherapy
10 days for patients <6 years old and /or patients with severe disease, TM perforation or recurrent AOM
5 - 7 days (with consideration of observation only in previously healthy individuals with mild disease) for patients ≥6 years old
Failure to improve and/or clinical worsening in 48 - 72 hours needs re-evaluated

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12
Q

AOM complication- Bullous Myringitis

A

Same as AOM (Amoxicillin 875mg BID)

May need to cover for atypicals
Mycoplasma
Zithromax

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13
Q

AOM complication- Typanic Membrane Rupture

A

Audiogram to check hearing (repeat in 3 months)
Oral and Topical antibiotics
Oral same as AOM
Amoxicillin
Augmentin
Cefdinir

Low ototoxicity topical Ab
Ofloxacin
Ciprodex

Earplugs when swimming and bath

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14
Q

Auditory Eustachian Tube Dysfunction

A

Systemic and intranasal decongestants
Autoinflation by forced exhalation against closed nostrils
Allergies
Intranasal steroids
Avoid air travel and altitude change, underwater diving

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15
Q

AOM complication- Chronic Otitis Media

A

Topical Ab: Ofloxacin or Cipro with dexamethasone for exacerbations
Oral: Ciprofloxacin 500 mg BID X 1-6 weeks

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16
Q

Barotrauma

A

Oral decongestants taken several hours before arrival time or topical decongestant 1 hr before
Attempt autoinflation
Myringotomy
VT tubes if patient flies often and has severe symptoms

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17
Q

Mastoiditis

A

IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone

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18
Q

Cholesteatoma

A

Refer - surgery
Surgical marsupialization or removal

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18
Q

Mastoiditis

A

IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone

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19
Q

AOM complications- Chronic otitis media definitive management

A

Definitive management is surgical in most cases
TM repair may be accomplished with the temporalis muscle fascia
Successful reconstruction of the TM may be achieved in about 90% of cases
Often with elimination of infection and improvement in hearing

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20
Q

URI

A

NO ANTIBIOTICS !!!

Symptomatic
NSAIDS/Acetaminophen
Fluids
Nasal saline irrigation
Oral decongestants
Nasal decongestants - limited to a few days

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21
Q

Acute Bacterial Rhinosinusitis Infection

A

Careful observation is acceptable “treatment”
Observation is recommended for 7-10 days in uncomplicated cases for people who are immune competent with reliable follow up
Up to 70% improve within two weeks without antibiotic treatment
NSAIDS, nasal saline sprays and intranasal decongestants have shown to help with symptom reduction
Oxymetazoline 1-2 sprays q6-8h for 3 days (Afrin)
Watch for rebound congestion (rhinitis medicamentosa)
Intranasal steroids have shown benefit in reducing symptoms (Flonase)
Antibiotic treatment controversial in uncomplicated cases of ABRS
Only 5% experience shortening of symptoms
May be considered complicated when symptoms last more than 7-10 days
Or when symptoms including fever, facial pain, or swelling are severe
Immunodeficiency, complicated (spreading to other places/tissues)

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22
Q

Acute Bacterial Rhinosinusitis

A

Antibiotics if NO risk factors
Amoxicillin - Clavulanate (Augmentin) - 500 mg/125 mg PO TID or 875 mg PO BID
Adding Clavulanate improves coverage for H. flu and M. cat
Evidence stronger in children for adding Clavulanate
Macrolides, Bactrim, 2nd and 3rd generation Cephalosporins not recommended due to high rates of resistance to S. pneumo
Antibiotics IF risk factors
Amoxicillin - Clavulanate - high dose - 2 grams PO BID

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23
Q

Invasive Fungal Sinusitis

A

Surgical debridement
IV Amphotericin B
Can switch to oral Itraconazole for 3-6 months after improvement

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24
Chronic Sinusitis
Refer to ENT Antibiotics - culture guided, prolonged courses 3 - 4 weeks Augmentin empirically Clindamycin for penicillin allergic Intranasal corticosteroids Nasal saline irrigation Sinus surgery Failure of medical tx Restoration of ventilation Improve penetration of topical medications Opens pathways, clears blockages
25
Chronic non-invasive Fungal Sinusitis
Difficult to cure Overall survival poor, long-term survivors may have significant sinonasal complications *IV Amphotericin B initial* Switch to Itraconazole for at least 3-6 months, some possibly lifelong
26
Allergic Fungal Sinusitis
Endoscopic sinus surgery to remove mucin and debris, created drainage Post-op systemic steroids mainstay Tapering course over 3 month period
27
Wegener's Granulomatosis
Steroids Immunosuppressants (for maintenance as well)
28
Allergic Rhinitis
Intranasal Glucocorticoids - most effective and mainstay of treatment: persistent, moderate to severe
29
Allergic Rhinitis
Antihistamines - little effect on congestion--first line for mild symptoms, intermittent 1st Generation Diphenhydramine (Benadryl), Hydroxyzine (Atarax, Vistaril), Chlorpheniramine, Brompheniramine Side Effects SEDATING, dry mouth, weight gain *2nd Generation: Generally first line Tx in intermittent, mild-intermittent symptoms* Generally preferred over 1st generation antihistamines d/t less sedating properties Going to someone’s house with pets; episodic Longer acting Cetirizine (Zyrtec), Loratadine (Claritin) Cetirizine is sedating in 10% of patients Fexofenadine (Allegra), Desloratadine (Clarinex), Levocetirizine (Xyzal) Side effects include dry mouth, antihistamine tolerance Can “rotate” medications
30
Mastoiditis
IV antibiotics 7-10 days Empiric until culture results available Ceftriaxane (Rocephin) 1g QD Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr Followed by oral antibiotics Amoxicillin/Clavulanate acid Cefdnir Myringotomy Surgical drainage of TM to allow drainage of middle ear fluid Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
30
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases TM repair may be accomplished with the temporalis muscle fascia Successful reconstruction of the TM may be achieved in about 90% of cases Often with elimination of infection and improvement in hearing
30
Cholesteatoma
Refer - surgery Surgical marsupialization or removal
30
Allergic Rhinitis Antihistamines and Deconestants
*Antihistamines* Nasal Antihistamines Azelastine (Astelin), Olopatadine (Patanase) Rapid onset Can improve nasal congestion *Decongestants* Oral Pseudoephedrine (Sudafed) Contraindications - narrow angle glaucoma, urinary retention, uncontrolled HTN, marked CAD or CVD, hyperthyroidism Topical Phenylephrine (Sudafed), Oxymetazoline (Zicam/Afrin)) Rebound vasodilation, rhinitis medicamentosa Side Effects Insomnia, tremor, tachycardia, hypertension
31
Allergic Rhinitis
Cromolyn sodium (NasalCrom): mast cell stabilizer Topical nasal spray Mast cell stabilizer Prophylactic Leukotriene antagonists Leukotrienes - inflammatory mediators produced by mast cells, basophils, and eosinophils, that are accompanied by the production of histamines and prostaglandins Trigger smooth muscle contraction Montelukast (Singulair) Used in the treatment of asthma as well Monotherapy or in combination with antihistamines Adverse effects Neuropsychiatric changes - dreams, insomnia, anxiety, depression, suicidal thinking
32
Allergic Rhinitis Anticholingergics
Anticholinergics Topical Ipratropium bromide Useful for post nasal drip and rhinorrhea Perennial symptoms Combined with intranasal steroids Useful in vasomotor rhinitis Adjunctive therapies Nasal saline irrigation
33
Vasomotor Rhinitis
Intranasal steroid or antihistamine Ipratropium Daily nasal saline lavage
34
Rhinitis Medicamentosa
Discontinue use of nasal decongestant Start intranasal corticosteroids
35
Nasal Polyps
Topical nasal steroids for 1 - 3 months Short course of oral steroids Surgical removal If medication unsuccessful
36
Mastoiditis
IV antibiotics 7-10 days Empiric until culture results available Ceftriaxane (Rocephin) 1g QD Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr Followed by oral antibiotics Amoxicillin/Clavulanate acid Cefdnir Myringotomy Surgical drainage of TM to allow drainage of middle ear fluid Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
36
Cholesteatoma
Refer - surgery Surgical marsupialization or removal
36
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases TM repair may be accomplished with the temporalis muscle fascia Successful reconstruction of the TM may be achieved in about 90% of cases Often with elimination of infection and improvement in hearing
36
Nasal Fractures
I&D with anterior nasal packing Antistapylococcal oral abx
37
Aphthous Stomatitis
Treatment No treatment has proven effective Supportive treatment Viscous lidocaine Topical corticosteroids in an adhesive base help with symptom relief Triamcinolone acetonide in Orabase One week tapering course of prednisone if severe 40-60 mg/day, then taper Magic Mouthwash diphenhydramine, nystatin, lidocaine diphenhydramine and mylanta
37
Mastoiditis
IV antibiotics 7-10 days Empiric until culture results available Ceftriaxane (Rocephin) 1g QD Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr Followed by oral antibiotics Amoxicillin/Clavulanate acid Cefdnir Myringotomy Surgical drainage of TM to allow drainage of middle ear fluid Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
37
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases TM repair may be accomplished with the temporalis muscle fascia Successful reconstruction of the TM may be achieved in about 90% of cases Often with elimination of infection and improvement in hearing
37
Cholesteatoma
Refer - surgery Surgical marsupialization or removal
38
Mastoiditis
IV antibiotics 7-10 days Empiric until culture results available Ceftriaxane (Rocephin) 1g QD Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr Followed by oral antibiotics Amoxicillin/Clavulanate acid Cefdnir Myringotomy Surgical drainage of TM to allow drainage of middle ear fluid Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
38
Cholesteatoma
Refer - surgery Surgical marsupialization or removal
38
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases TM repair may be accomplished with the temporalis muscle fascia Successful reconstruction of the TM may be achieved in about 90% of cases Often with elimination of infection and improvement in hearing
39
Herpes Gingivostomatitis
Antivirals effective to shorten the course if started within 24-48 hours of onset of symptoms (pain, burning, itching) Not effective once vesicles have erupted Acyclovir 200 – 800mg five times daily x 7-10 days Valacyclovir (Valtrex) 1000mg BID x 7-10 days Viscous lidocaine 2% Antivirals also available in topical preparations
40
Oral Candidiasis
Nystatin 100,000 units/mL Fluconazole (Diflucan) 100 mg Magic mouthwash Nystatin, lidocaine, Benadryl, Maalox or Mylanta
41
Angular Chelitis
Topical antifungal cream or ointment applied twice daily Clotrimazole or Miconazole
42
Glossitis
If the primary cause cannot be identified, then empiric nutritional replacement therapy may be of value
43
Glossodynia
No specific treatment (underlying cause) clonazepam: works on GABA receptors, have on tongue TCA’s Behavioral therapy
44
Leukoplakia
No known treatment to date that will reverse leukoplakia Surgically remove areas of leukoplakia Advise patients to eliminate contributory factors Tobacco, alcohol Follow up Close follow up is warranted every 3 months in first year, then yearly
45
Erythroplakia
If identified, refer to specialist for biopsy and treatment Surgical excision with clear margins Otolaryngologist, head and neck surgeon, or radiation oncologist Advise to eliminate contributory factors Tobacco, alcohol
46
Hairy Leukoplakia
Not technically needed Highly Active Antiretroviral Therapy (HAART) Acyclovir or Valcyclovir show modest improvement Topical Podophyllin (cytotoxic agent)
47
Geographic tongue
No treatment necessary
48
Hairy Tongue
Improve oral hygiene Smoking cessation Tongue scrapers
49
Sialolithiasis
Local heat Massage Hydration Small stone - salivary secretion first line Sialogogues (Salagen, Evoxac) Sour candy If no improvement Incise duct remove stone Sialendoscopy Large stone – interventional removal of duct
50
Suppurative Parotitis
IV antibiotics initially d/t possible spread to deep neck tissue Nafcillin or 1st generation Cephalosporin PLUS either Metronidazole or Clindamycin Vancomycin or Linezolid (Zyvox) if MRSA suspected Can switch to oral antibiotics when clinical improvement Clindamycin plus Ciprofloxacin Or Amocicillin/Clavulanate Acid alone Hydration Surgical I&D if no clinical response after 48 hours of IV antibiotics
51
Sialadenitis: Submandibular Gland
Hydration Warm compresses IV Abx same as Parotid Sialadenitis I&D if abscess formation or unresponsive to abx.
52
Dental Caries (fluoride use)
Fluoride Use Oral drops, chewable tablet: Prevention of dental caries (FDA approved in ages 6 months to 16 years; consult specific product formulations for appropriate age group) Lozenges: Prevention of dental caries (FDA approved in ages ≥ 6 years and adults) Gel, paste, oral rinse: Prevention of dental caries (Prescription and OTC products: FDA approved in ages ≥ 6 years and adults; consult specific product formulations for appropriate age group); reduction of tooth sensitivity (Prevident 5000 sensitive: FDA approved in ages ≥ 12 years and adults) Fluoride varnish: Treatment of hypersensitive teeth, sensitive root surfaces, and as a cavity preparation to seal dentinal tubules (Approved in ages ≥ 6 months to 5 years); has also been used for prevention of dental caries
53
Dental Abscess small and large
Small abscesses PCN VK treatment of choice +/- Metronidazole If Penicillin allergic: Clindamycin Analgesics Chlorhexidine mouth rinses Large abscesses I&D +/- IV antibiotics Dental referral
54
Gingivits
Good oral hygiene practices Tooth brushing Flossing
55
Acute Necrotizing Ulcerative Gingivitis
Debridement Metronidazole or Clindamycin or Augmentin Warm, ½ strength peroxide rinses or Chlorhexidine rinses as adjunct
56
Mastoiditis
IV antibiotics 7-10 days Empiric until culture results available Ceftriaxane (Rocephin) 1g QD Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr Followed by oral antibiotics Amoxicillin/Clavulanate acid Cefdnir Myringotomy Surgical drainage of TM to allow drainage of middle ear fluid Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
56
Cholesteatoma
Refer - surgery Surgical marsupialization or removal
56
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases TM repair may be accomplished with the temporalis muscle fascia Successful reconstruction of the TM may be achieved in about 90% of cases Often with elimination of infection and improvement in hearing
57
Viral Pharyngitis-Influenza
Supportive care for all viruses Fever reducers/pain relievers, magic mouthwash, cold food Tamiflu Within 48 hours of symptoms onset
58
Viral Pharyngitis-HSV
Supportive care for all viruses Fever reducers/pain relievers, magic mouthwash, cold food Acyclovir / Valacyclovir (Valtrex)
59
Viral Pharyngitis
Supportive care for all viruses Fever reducers/pain relievers, magic mouthwash, cold food Avoid contact sports for 4 weeks Risk of splenic rupture Can use oral Prednisone taper if tonsillar swelling is significant Antivirals and Steroids not recommended in regular treatment; does not reduce duration
60
Group A Streptococcus
*Pen VK* Pen G benzathine (Bicillin) IM as a single dose Amoxicillin Cephalexin (Keflex)/ Cefdinir / Cephalosporins Penicillin allergic reaction of rash Azithromycin / Clindamycin Anaphylaxis reaction
61
Group A Strep Patient Education
Have pt change toothbrush after 24 hours Not contagious any longer after 24 hours of treatment Strep will “go away” on it’s own without antibiotics However, a patient will remain contagious for 2-3 weeks after symptoms abate
62
Group A Strep second line
Augmentin Erythromycin Clindamycin Azithromycin (Zithromax)
63
Retropharyngeal Abscess
Airway first Empiric IV antibiotics Ampicillin / Sulbactam (Unasyn) or Ceftriaxone plus Metronidazole or Clindamycin plus Levofloxacin Surgical drainage of abscess with ultrasound guided needle aspiration or open drainage Clinical improvement should be seen within 24 - 48 hours Consider new antibiotics and / or surgery if not Otolaryngologist consult Continue IV treatment until afebrile and able to tolerate oral antibiotics Metronidazole or Levofloxacin Total of 2-3 weeks
64
Laryngitis
Viral Voice rest Hydration Bacterial Antibiotics PCN Erythromycin Supportive care Actors/singers Can be given oral steroids or erythromycin to help speed up recovery for performances
65
Croup
Dexamethasone Nebulized Epinephrine Supportive care including humidified air or oxygen, antipyretics, fluid intake, nebulized saline Oral Prednisone also an option?
66
Epiglottitis
Cellulitis of the supraglottis and surrounding structures Without treatment, can progress to life-threatening airway obstruction Results from bacteremia and or direct invasion of the epithelial layer by the pathogenic organism The posterior nasopharynx is the primary source of pathogens in epiglottitis Airway emergency in children Caused by Haemophilus influenzae type B Vaccinate!!! Also caused by caustic ingestion, foreign body, thermal injury
67
Epiglottitis
Empiric IV antibiotic treatment should begin after blood and epiglottic cultures are obtained *3rd Generation Cephalosporin (Ceftriaxone) plus Vancomycin first line* 3rd Generation Cephalosporin (Ceftriaxone) plus Clindamycin also accepted as first line If anaphylaxis occurs with penicillin, can use Vancomycin plus fluoroquinolone Most will treat for 7-10 days Antipyretics + / - steroids
68
Ludwig's Angina
Admit to hospital CT with IV contrast imaging of choice Close monitoring of airway and possible intubation Empiric IV antibiotic Ampicillin-sulbactam (Unasyn) alone Ceftriaxone plus metronidazole For penicillin allergic: Clindamycin plus levofloxacin Obtain culture via needle aspiration if possible May need surgical drainage However, this is not a typical abscess, so there is usually nothing to drain initially
69
Tumors on Larynx
Vocal cord nodules Voice habit modification +/- surgical excision Vocal cord polyps Lifestyle change Inhaled steroid spray Removal Squamous cell carcinoma Surgery Radiation and / or chemotherapy
70
Vocal cord paralysis
Maintain airway Unilateral is occasionally temporary, may resolve spontaneously May take at least a year Surgery may be needed
71
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases TM repair may be accomplished with the temporalis muscle fascia Successful reconstruction of the TM may be achieved in about 90% of cases Often with elimination of infection and improvement in hearing
71
Cholesteatoma
Refer - surgery Surgical marsupialization or removal
71
Mastoiditis
IV antibiotics 7-10 days Empiric until culture results available Ceftriaxane (Rocephin) 1g QD Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr Followed by oral antibiotics Amoxicillin/Clavulanate acid Cefdnir Myringotomy Surgical drainage of TM to allow drainage of middle ear fluid Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
71
TMJ
Joint rest To allow muscles of mastication to relax Reduce mandibular condyle movement Avoid chewing gum, biting nails, excessive talking Eat a soft diet Reduce stress Physical therapy Exercises include mouth opening and closing in a straight line Intra-oral devices Splints, night guards, bite guards Botox injections Muscle relaxation Only temporary relief 3-4 months
72
Mastoiditis
IV antibiotics 7-10 days Empiric until culture results available Ceftriaxane (Rocephin) 1g QD Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr Followed by oral antibiotics Amoxicillin/Clavulanate acid Cefdnir Myringotomy Surgical drainage of TM to allow drainage of middle ear fluid Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
73
Cholesteatoma
Refer - surgery Surgical marsupialization or removal
73
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases TM repair may be accomplished with the temporalis muscle fascia Successful reconstruction of the TM may be achieved in about 90% of cases Often with elimination of infection and improvement in hearing

Clin Med 1B Exam 2 (2 decks)

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