ENT/Ophthalmopathy

Question 1

Which ear infections do we use 0.3% ciprofloxacin therapy

Answer 1

otitis externa and bilateral otitis media in children undergoing a tympanostomy

Question 2

In which cases do we not use 0.3% ciprofloxacin therapy
a. otitis media
b. otitis externa
c. bilateral otitis media
d. mastoiditis

Answer 2

d

Question 3

What is a severe complication of acute otitis media

Answer 3

mastoiditis

Question 4

What are the three signs of mastoiditis on observation

Answer 4

ear discharge, tender oedematous mastoid and anterolateral protrusion of the auricle

Question 5

What is the difference between the typical presentation of acute otitis media and otitis media with effusion

Answer 5

acute otitis media has tympanic membrane is bulging and erythematous, opacification and loss of light reflex there, otitis media with effusion is retracted and opacification of the TM. This also does not have fever or or pain in the ear

Question 6

Which of the following is the best suited differential for a yellow or white mass behind the tympanic membrane

Answer 6

congenital cholesteatoma

Question 7

What is the most suited differential of vesicles in the ear, ear pain and irritability

Answer 7

herpes zoster oticus

Question 8

What are three conditions where you would see a retracted tympanic membrane

Answer 8

early acute otitis media, otitis media with effusion and respiratory infections

Question 9

Which common pathogens cause acute otitis media

Answer 9

Hemophilus influenza, Strep pneumoniae usually bacterial after a viral infection

Question 10

What are the main risk factors for acute otitis media

Answer 10

passive cigarette smoke and day cares

Question 11

What are the general findings and presentation and investigation for acute otitis media in children

Answer 11

general findings: otalgia, otorrhea, fever, hearing loss in the affected ear
presentation: fiddling with affected ear, reduced feeding, irritability
investigation: bulging and erythematous TM, opacification and loss if light reflex, ear discharge and conducive hearing loss on weber and rinnes tests

Question 12

When would you not diagnose acute otitis media with presentation and otoscopy alone and what would you do extra

Answer 12

in the case of patients who do not respond to initial therapy, have immune deficiencies and are acutely ill we would use a gram stain and culture of pus in the ear

Question 13

What is the conservative management for otitis media

Answer 13

acetaminophen and ibuprofen (oral analgesia) and monitor for 48-72 hours and this would do this for unilateral AOM

Question 14

What is the systemic treatment for AOM and when would you do it

Answer 14

first line: amoxicillin
if allergic to penicillin use clarithromycin or azithromycin
you could consider this in infants under 6 months, severe infections, bilateral under 2 years, if it has not improved after 72 hours, cochlear implants

Question 15

What are the 2 surgical procedures for AOM

Answer 15

Myringotomy: hole in the TM
Tympanostomy: hole with tube in TM to drain out the fluid

Question 16

What is a severe complication for AOM

Answer 16

mastoiditis