EM: EENT just ENT Flashcards
Infection/inflammation of the external auditory canal and auricle
Otitis externa
Historical findings of otitis externa
- Pruritis
- Otalgia
- Tenderness of external ear, worse with mastication/movement of auricle
- Otorrhea and decreased hearing in more severe presentations
;
Physical exam of otitis externa
- Erythema and edema of external auditory canal, spreading to tragus and auricle
- Clear-purulent discharge with crusting of external canal
- Severe cases: complete occlusion of auditory canal, periauricular edema/erythema, lymphadenopathy
Management of otitis externa
- Analgesics: tylenol/motrin
- Cleansing of external canal with hydrogen peroxide 1:1 with warm saline or water and gentle suction under direct visualization
- Otic drops: acetic acid/hydrocortisone
- Ofloxacin or ciprofloxacin/hydrocortisone
- Ear wick
When would acetic acid/hydrocortisone be contraindicated?
- perforated TM or unable to visual TM
- Can only be used alone in mild disease
When should ciprofloxacin HC be avoided in otitis externa? What could you use instead?
- if suspected or confirmed TM perforation
- Ofloxacin
When is an ear wick indicated?
If swelling severe and prevents full application of ear drops
Clinical presentation of malignant otitis externa
- Potentially life-threatening extension of infection to deeper tissues of EAC
- Red flags: elderly, diabetic/immunocompromised
- Persistent symptoms despite standard therapy (2-3 weeks)
- Severe otalgia and edema; granulation tissue on floor may be seen
- CN VII first to be affected
Diagnosis of malignant otitis externa
CT head with contrast, bone erosion noted on report
Management of malignant otitis externa
- Urgent ENT consult
- IV antibiotics: tobramycin plus piperacillin OR ceftriaxone OR ciprofloxacin
- Pain control: IV opiate usually needed
- Admission with ENT consult
Grandma toby and piper or roce or cipro
Infection of inner ear
Otitis media
Clinical presentation of otitis media
History of otalgia +/- fever, otorrhea, hearing loss
* PE: TM erythema, yellow/white exudate behind intact TM or in canal if TM perforated, retracted or bulging with impaired mobility
Management of otitis media
- Oral antibiotics: amoxicillin (cefdinir or zithromax alternatives)
- Augmentin or cefdinir if recent abx use or recurrent OM
- Analgesics: tylenol/motrin
media= moxi augment it or eat dinner if recent abx or recurrent
Disposition of otitis media
Home to f/u with PCP in 3-5 days
Complication of OM in which infection spreads to mastoid cells
Acute mastoiditis
Clinical presentation of acute mastoiditis
- History of otalgia, fever, postauricular pain and swelling
- PE findings same as OM + protrusion of auricle with loss of postauricular crease, postauricular erythema, swelling and tenderness
Diagnosis of acute mastoiditis
CT head with contrast: mastoid “clouding” early in disease; loss of bony septae of mastoid air cells, destruction/irregularity of mastoid cortex, periosteal thickening
Management of acute mastoiditis
Emergent ENT consult, IV vancomycin and ceftriaxone, admission
three mastifs in vans
complication of OM characterized by bullae formation on TM and deep external auditory canal
Bullous myringitis
History in bullous myringitis
- Severe otalgia
- Intermittent otorrhea due to ruptured bullae
- Hearing loss (reversible)
PE in bullous myringitis
- Intact bullae along TM and EAC
- Blood filled, serous, serosanguineous
- Middle ear effusion
Treatment of bullous myringitis
- Amoxicillin (or cefdinir, zithromax)
- Augmentin or cefdinir if recent abx or recurrent OM
- Tylenol/motrin
same as otitis media!
Accumulation of blood between the skin adn the cartilage of tha uricle due to blunt trauma
Hematoma
Clinical presentaiton of hematoma
- Swelling
- Pain
- Ecchymosis of auricle