ENT I: Middle + Inner Ear Disorders Flashcards
Pt 2 of the first ppt
1) Define middle ear effusion
2) Define acute otitis media
3) Define otitis media with effusion (OME)
1) Fluid in middle ear cavity (occurs with acute otitis media & otitis media with effusion)
2) Acute bacterial infection of middle ear (aka suppurative otitis media)
3) Middle ear fluid, but is not infected (aka serous, secretory, or nonsuppurative otitis media)
1) What is Acute Otitis Media (AOM)?
2) What often is the cause? What is this usually precipitated by in adults?
3) Who is it most common in?
1) Acute bacterial infection of middle ear fluid (aka, suppurative otitis media)
2) Obstruction of the eustachian tube; viral URI or seasonal allergic rhinits
3)Infants & children (ages 6-24 mos)
1) Are bacteria or viruses the more common cause of AOM?
2) What are the 3 most common bacteria?
3) What are 6 common viruses?
1) Bacteria
2) Streptococcus pneumonia, Haemophilus influenzae, & Moraxella catarrhalis
3) Rhinovirus, RSV, parainfluenza, coronavirus, adenovirus, COVID-19
Describe the symptoms of Acute Otitis Media (AOM) in young children, children, and adults
1) Young children/infants: fever, fussiness, disturbed or restless sleep, poor feeding/anorexia, vomiting, diarrhea
2) Children: otalgia, ear rubbing, hearing loss, ear drainage, + fever
3) Adults: otalgia, decreased/muffled hearing, purulent otorrhea (TM rupture)
1) What is necessary for AOM?
2) What may be a necessary procedure?
1) Accurate diagnosis is vital & otoscopy is necessary
2) Cerumen removal
Describe the classic exam findings of acute otitis media (AOM). Include the results of pneumatic otoscopy.
1) Middle ear effusion
2) TM that is bulging, opaque, yellow, or white
3) TM with decreased or absent mobility
4) Pneumatic otoscopy: painful in children with AOM & not necessary with bulging TM
Diagnosis of AOM is made clinically from seeing one of what two things?
1) Bulging of the TM
OR
2) Perforation of TM with acute purulent otorrhea (if acute otitis externa has been excluded)
For AOM, what should you assess the TM for?
1) Position, mobility, color, & translucency
2) Bulging, air-fluid levels, perforation, retraction pockets, & cholesteatoma.
What are the two strategies for AOM treatment in kids? What do both have in common?
1) Immediate treatment with antibiotics
OR:
2) Observation with initiation of antibiotic therapy if signs & symptoms worsen or fail to improve after 48-72 hours (different criteria depending on reference used)
-Both: PO ibuprofen or acetaminophen (alternate topical anesthetics), tympanocentesis, or myringotomy
What does effusion mean in the context of ENT?
Fluid in middle ear
What 4 groups of children are at risk for severe infection, complications, and/or recurrent AOM?
1) Infants < 6 months
2) Immunocompromised
3) Toxic-appearing
4) Craniofacial abnormalities (ie, cleft palate)
What is the difference in treatment between AOM treatment in at-risk kids and not at-risk kids?
1) At-risk: immediate antibiotic therapy
2) Not at-risk: immediate antibiotic therapy or observation
1) How should you treat AOM with antibiotics in children if they haven’t had antibiotics in the past month?
2) What about if they have?
3) How long should it last?
4) In most cases you should treat children ages <_____ y/o with antibiotics.
1) Amoxicillin 80-90 mg/kg/day divided q8h or q12h
2) Amoxicillin-clavulanate (Augmentin) 90/6.4 mg/kg/day PO divided BID
3) Duration of therapy: 10 days for < 2 y/o & 5-7 days for > 2 y/o
4) <2 y/o
What are the two main treatment options for kids w AOM? (review)
1) Immediate treatment with antibiotics
2) Observation with initiation of antibiotic therapy if signs & symptoms worsen or fail to improve after 48-72 hours.
1) How should you treat AOM in kids with a PCN/ beta-lactam allergy if the rxn is not severe (i.e. rash)?
2) What about if there’s a severe allergy to PCN/beta-lactam or cephalosporins?(i.e., anaphylaxis, urticaria, angioedema, Stevens-Johnson syndrome)
1) Oral cephalosporin (i.e., cefdinir)
2) Avoid cephalosporins & use a macrolide (i.e., clindamycin)
slide 57
1) How should you treat adults for AOM?
2) How should low-risk adults be treated?
3) How should high risk adults be treated?
4) What’s the alternate treatment?
1) Treat all adults with antibiotics! (and acetaminophen or ibuprofen for pain
2) Amoxicillin-clavulanate
-875/125 mg 1 tab PO BID
-1000/62.5 mg 2 tabs PO BID
3) Amoxicillin-clavulanate (higher dose)
-1000/62.5 mg ER 1 tab PO BID (lower weight or milder infection)
-2000/125 mg ER 1 tabs PO BID (higher weight or more severe infection)
4) Cephalosporin (i.e., cefpodoxime, cefdinir)
1) How should you treat adults with PCN allergy for AOM if there’s no severe rxn i.e., rash) or no known allergy to cephalosporin?
2) What about if known severe allergy to PCN or known severe allergy to cephalosporins (i.e., anaphylaxis, urticaria, angioedema, Stevens-Johnson syndrome)?
1) Oral cephalosporin (i.e., cefdinir, cefpodoxime, cefuroxime)
2) Avoid cephalosporins & use doxycycline or a macrolide (i.e., azithromycin, clarithromycin)
1) True or false: most TM perforations in both children and adults assoc. with AOM heal spontaneously
2) True or false: there’s data showing benefit of combination topical & PO antibiotics vs PO antibiotics alone (children & adults)
1) True
2) False; there’s no data showing that
1) How should you treat children with perforated TM assoc with AOM?
2) What abt for adults?
3) What should you counsel both on?
1) PO antibiotics only
2) If topical antibiotic added, avoid topicals with ototoxicity (aminoglycosides) & treat for 7-10 days.
3) Appropriate water precautions until healed
1) What often precedes AOM?
2) True or false: For AOM persistence of middle ear effusion after the resolution of acute symptoms is common
3) What are some potential complications of AOM?
1) Middle ear effusion often precedes AOM
2) True
3) Mastoiditis, labyrinthitis, cholesteatoma, meningitis, brain abscess, epidural or subdural abscess, lateral or cavernous sinus thrombosis
What are the 3 referral criteria for AOM?
1) Recurrent otitis media (> 2 episodes in 6-month period)
2) Persistent hearing loss following AOM (> 1-2 weeks)
3) Chronic TM perforation (> 6 weeks)
1) Define chronic otitis media.
2) What’s its hallmark?
3) What is it usually a consequence of?
4) What are 3 commonly involved bacteria?
5) What are its symptoms?
6) What is it commonly associated with?
1) Recurrent infection of middle ear and/or mastoid in presence of TM perforation
2) Purulent aural discharge
3) Recurrent AOM
4) P. aeruginosa, Proteus species, S. aureus
5) Hearing loss, aural fullness, otalgia, & occasionally vertigo
6) Cholesteatoma
1) How is chronic otitis media diagnosed?
2) How is it treated?
3) What should you avoid?
1) Persistent (6-12 weeks) purulent otorrhea with perforated TM despite treatment
2) Removal of infected debris, earplugs, topical antibiotic drops (ciprofloxacin or ofloxacin) x 2-4 weeks, consider PO ciprofloxacin
-Possible surgical reconstruction of TM
3) Avoid aminoglycosides (ototoxicity)
1) Define Otitis Media with Effusion (OME) (aka Serous Otitis Media)
2) What does it often occur after?
3) Who is it more common in, kids or adults?
4) What is the criteria for chronic OME?
1) Presence of middle ear effusion without signs of acute infection
2) Often occurs after AOM, but may occur with ETD (in absence of AOM)
3) Children (pre-school)
4) _/>3 months
1) What are rarely associated w OME (serous otitis media)?
2) What are the risk factors for OME?
1) Rare obstruction of eustachian tube by mass (NP carcinoma) or radiation Tx (nasopharyngoscopy + CT for recurrent unilateral OME)
2) FHx of otitis media (otitis-prone parents), bottle feeding, male, daycare (or in-person school) attendance, adenoidal hypertrophy, exposure to tobacco smoke, low socioeconomic status
1) What is the main sign of OME?
2) What are the other signs and symptoms of OME?
3) List 5 common exam/ otoscopic OME findings
1) Conductive hearing loss (predominant)
2) Feeling of ear fullness, tinnitus, balance problems
3) Impaired mobility of TM, type B tympanometry, air-fluid levels + bubbles, amber (or gray) middle ear fluid, neutral or retracted TM
What are the 3 main ways OME is diagnosed? What is within each category?
1) Standard otoscopy
2) Pneumatic otoscopy
3) Adjunctive testing:
-Audiology (CHL + flat tympanogram suggests OME)
-Tympanometry
-Acoustic reflectometry
What are the two main treatments of OME for children?
1) Watchful waiting (most common)
2) Myringotomy with T-tube placement (w/wo adenoidectomy)
1) What are unproven/ ineffective OME treatments?
2) When do most cases spontaneously resolve?
1) Antibiotics, PO & intranasal steroids, nasal balloon auto-inflation, antihistamines, decongestants, complementary & alternative therapies, myringotomy alone
2) In 3-6 months