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NURS 502 > Exam 1 - Otitis media > Flashcards

Exam 1 - Otitis media Flashcards

1
Q

Is acute otitis media more common in adults or children?

A

Common in children <5 years

  • Due to position of eustacian tube (more horizontal and narrow)
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2
Q

What organisms cause AOM?

A

Can be caused by bacteria and viruses

  • S. pneumo, h. influenzae, moraxella catarrhalis, s. pyogenes
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3
Q

AOM risk factors

A
  • URI
  • Allergies
  • Cleft palate
  • Adenoid hypertrophy
  • Tobacco exposure
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4
Q

AOM symptoms

A

Worse when lying down

  • Ear pain
  • Ear pulling (infant/toddler)
  • Fever
  • Otorrhea
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5
Q

Diagnostic findings of AOM

A
  • Recent onset middle ear inflammation and effusion
  • Bulging TM, decreased mobility, air fluid level
  • Otorrhea
  • TM erythema and pain
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6
Q

True/false: redness of TM should not be used alone to diagnose AOM

A

True - redness can occur as result of fever or child crying

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7
Q

What tool would be helpful in diagnosing AOM?

A

Pneumatic otoscope - will demonstrate decreased TM mobility

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8
Q

Mild versus severe AOM: temperature and time of onset difference

A

Mild: temperature <39 C, symptoms occur <48 hours

Severe: temperature >39 C, symptoms occur >48 hours

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9
Q

How would the provider manage pain associated with AOM?

A
  • Heat or cold compresses
  • Distraction
  • Acetaminophen or ibuprofen in children >6 months
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10
Q

When is antibiotic therapy warranted for children with AOM?

A
  • <6 months or any age with underlying condition
  • Children more than six months old with severe signs; otalgia for >48 hours
  • 6-23 months old with mild or severe bilateral AOM
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11
Q

For which patients would the provider observe with close follow up instead of starting antibiotic therapy?

A

6-23 months old with non-severe unilateral AOM and any child >24 months with non-severe bilateral or unilateral AOM

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12
Q

What medication is considered first line for AOM treatment (both adults and children)?

A

Amoxicillin

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13
Q

What is the alternative to amoxicillin if patients cannot take that for AOM?

A

Amoxicillin-clavulanate is next in line if amoxicillin taken in past 30 days or if the patient also has conjunctivitis

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14
Q

What medication can be prescribed if a patient has a PCN allergy when determining treatment for AOM?

A

Cephalosporin - if non-type 1 hypersensitivity reaction to PCN

  • Cefdinir, cefuroxime, cefpodoxime, ceftriaxone
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15
Q

What is the usual dose of antibiotic therapy when treating AOM?

A

If <2 years old, treat for 10 days

If >2 years old, treat for 5-7 days

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16
Q

Can smoking cessation and getting a flu shot prevent AOM?

A

Yes - improvement should be seen in 3 days

17
Q

AOM complications: mastoiditis

  • Symptoms
A
  • Fever
  • Pain in ear
  • Swelling posterior to ear and right over mastoid process
18
Q

Does mastoiditis require emergency care?

A

Yes - requires urgent ENT referral

19
Q

AOM complications: perforation

  • Symptoms
  • Treatment
A

Severe pain that suddenly disappears with perforation, otorrhea

Treatment: otic drops (ciprofloxacin), oral antibiotics

20
Q

AOM complications: perforation

  • Management
A

Heals within a few weeks, but requires close follow up

  • Should not allow water to get into ear
21
Q

AOM complications: AOM with effusion

  • Symptoms
A

Does not cause pain, but causes feelings of pressure

  • If symptoms persist longer than 3 months, refer for hearing testing
22
Q

What should the provider do if a patient has hearing loss after an AOM effusion?

A

Consider inserting a t-tube and ENT referral

23
Q

AOM complications: cholesteatoma

  • What is this?
A

Epidermal inclusion cyst of middle ear

Pearly white lesion on TM

24
Q

AOM complications: cholesteatoma

  • Symptoms
A

May have hearing loss, vertigo, but can be asymptomatic

  • Referral to ENT
25
Q

What is acute otitis externa?

A

Aka “swimmers ear”

  • Inflammation of external ear canal due to moisture in ear thus allowing bacterial growth
26
Q

Acute otitis externa symptoms

A
  • Pain
  • Hurts when ear is touched (tender when tragus or auricle is palpated)
  • Drainage
  • Itching
  • Fullness
  • Hearing loss
  • Edema, erythema in ear canal
27
Q

Acute otitis external risk factors

A

Putting foreign bodies in ear (earbuds, q tips)

28
Q

When should the provider consider cause of ear pain to be fungal?

A

Consider fungal infection if treatment of AOM with antibiotics doesn’t work

29
Q

Acute otitis externa differential diagnosis

A
  • AOM
  • TMJ (pain can refer to jaw)
  • Fungal infection
30
Q

Acute otitis external treatment

A

Uncomplicated - topical antibiotic ear drops (improves in 5-7 days)

31
Q

Acute otitis externa patient education

A
  • Ear wax has protective function (don’t clean with q tips)
  • Keep ear dry, avoid swimming or submerging head until infection is cleared
  • Use hair dryer when coming out of pool or shower

NURS 502 (43 decks)

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