ENT/Ophthalmology (15%) Flashcards
Acute Otitis Media (AOM)
General Info
- infection of middle ear +/- temporal bone and mastoid air cells
- rapid onset
- peaks @ age 6-18 months
- RF = daycare, 2nd hand smoke, not being breastfed, pacifier use
- MC bugs = S. pneumo, H. flu, M. catarrhalis
- Patho = usually preceded by viral URI leading to blockage of eustachian tubes (stagnant fluid, infection)
Acute Otitis Media (AOM)
Clinical Manifestation
- fever, otalgia / ear pulling, irritability / fussiness, decreased appetite, decreased hearing (saying huh, having to repeat self to child a lot, louder TV volumes)
- TM rupture = relief of pain + new otorrhea (heals in 1-2 days)
Exam
* bulging and erythematous TM w/ loss of landmarks +/- effusion
Acute Otitis Media (AOM)
Diagnostics
- pneumatic otoscopy = decreased TM mobility
- Recurrent = tympanocentesis to culture fluid
- most cases do not need testing
Acute Otitis Media (AOM)
Management
First line = Amoxicillin 90mg/kg/day x 10-14 days
* second line = Augmentin (concurrent conjunctivitis), Cefuroxime, Cefdinir
* PCN allergy? Azithromycin
* Severe / recurrent = myringotomy with tympanostomy tube placement (3x in 6 mo OR 4x in 12 mo)
* Recurrent? work-up for IDA
Otitis Externa (AOE / OE)
General Info
- inflammation of EAC
- RF = recent swimming / water immersion (rise in pH allows for bacterial overgrowth), local mechanism trauma (q-tips, cerumen impaction, itching)
- Bugs = Pseudomonas most common, S. aureus, S. epidermidis, GABHS, proteus, anaerobes, fungi, yeast
Otitis Externa (AOE / OE)
Clinical Manifestation
- ear pain + pruritis + drainage
- ear pressure or fullness / hearing loss
- PE = pain on traction of ear canal or tragus, purulent auricular discharge
Otitis Externa (AOE / OE)
Diagnostics
- clinical diagnosis BUT can do otoscopy = erythema, debris, discharge
- Rhinne = BC > AC
- consider culture to r/o fungi or yeast
Otitis Externa (AOE / OE)
Management
- keep ear DRY = isopropyl alcohol & acetic acid dry agents
- Topical abx drops = Cipro-dexamethasone (Cipradex), Ofloxacin, or Neomycin / PolymyxinB / hydrocortisone
- Perf ? Cipro/dexamethasone or Ofloxacin
Mastoiditis
General Info
- infection of mastoid ear cells of temporal bone
- largely disease of childhood (esp < 2 years)
- usually complication of AOM
- Bugs = S. pneumoniae, H. flu, M. catarrhalis, S. aureus, S. pyogenes
Mastoiditis
Clinical Manifestations
- deep ear pain worse at night
- fever, lethargy, malaise
- PE = otalgie, fever, bulging / erythematous TM, mastoid tenderness / edema / erythema,
- forward protrusion of ear = narrowed auditory canal
Mastoiditis
Diagnostics
CT w/ contrast of Temporal bone
Mastoiditis
Management
- IV abx (Vanco or Clindamycin) x4 weeks
- Middle ear / mastoid drainage (myringotomy) +/- tympanostomy tubes
- Refractory/complicated = mastoidectomy
Acute Pharyngitis / Tonsillitis
General Info
- usually viral; adenovirus, rhino/entero, EBV, influenza, RSV
- consider fungal in older pts using inhaled steroids
Acute Pharyngitis / Tonsillitis
