ENT

Question 1

what are the most common pathogens in acute diffuse otitis externa?

Answer 1

pseudomanas and staph aureus.
Candida and aspergillus are the most common fungal pathogens

Question 2

treatment of otitis externa should include?

Answer 2

dry aural tileting Q6H followed by :
dexamethosone + framycetin + gramicidin (0.5/0.05/0.005%) 3 drops TDS 7 days

Question 3

your patient with otitis externa has a perforated TM, how will you manage this?

Answer 3

avoid aminoglycoside. Use ciprofloxacin + hydrocortisone 0.2% + 1% - 3 drops BD 7 days

Question 4

your patient presents with severe ear pain, fever and occluded external ear canal. How do you treat them?

Answer 4

Ear wick plus drops (dex/fram/gram TDS 7 days)
PLUS
dicloxacillin OR flucloxacillin 500mg PO Q6H 7-10 days (kids 12.5mg/kg)
PLUS
ciprofloxacin 750mg PO BD 7-10 days (20mg/kg)

penicillin allergy
clindamycin 450mg OP Q8H 7-10 days (10mg/kg)
PLUS
ciprofloxacin 750mg PO BD 7-10 days (20mg/kg)

Question 5

A mum brings her child back who you commenced on dicloxacillin for severe otitis externa as the child won’t take it, what do you change to?

Answer 5

cefalexin 12.5mg/kg PO Q6H for 7-10 days
PLUS
ciprofloxacin 20/mg/kg PO BD 7-10 days

Question 6

you patient with severe otitis externa has a penicillin allergy - what is the treatment?

Answer 6

clindamycin 450mg OP Q8H 7-10 days (10mg/kg)
PLUS
ciprofloxacin 750mg PO BD 7-10 days (20mg/kg)

Question 7

treatment to prevent recurrent otitis externa

Answer 7

ear plugs when swimming, shower caps, and acetic acid isoprpyl alcohol drops 4-6 drops to ear after water exposure

Question 8

necrotising otitis externa is rare, and would be most likely be seen in which patients?

Answer 8

patients with diabetes, or in elderly or immunocompromised patients

Question 9

your patient fails to respond to treatment for otitis externa and has worsening fevers, severe pain and on exam you see ganulation tissue.
What treatment do they require?

Answer 9

This is necrotising
otitis externa
ceftazidime 2g (50mg/kg) IV Q8H
OR
pip-taz 4+0.5mg (100+12.5mg) IV Q6H

cipro 400mg IV Q8H if penicillin allergy

Question 10

paediatric treatment acute otitis media?

Answer 10

amox 15mg/kg Q8H 5 days (30mg/kg BD if adherance difficult)

Question 11

treatment of an indigenous child with high risk otitis media or a high risk patient?

Answer 11

25mg/kg BD for 7 days OR a single dose of aziromycin 30mg/kg