HEENT

Question 1

treatment for acute otitis externa

Answer 1

• uncomplicated:
  
  • topical antimicrobials or antibiotics
  • acetic acid
  • aminoglycosides
  • polymyxin B
  • quinolones (e.g. ofloxacin 0.3% 5 drops in ear x 10D)
  • addition of corticosteroids may resolve syptoms more quickly
• persistent infection, even with topical tx:
  
  • add oral abx

Question 2

Most common pathogens causing acute otits externa

Answer 2

• psuedomonas aeruginosa
• staphylococcus aureus

Question 3

symptoms of acute otitis externa

Answer 3

• rapid onset
• ear canal inflammation
• otalgia
• itching
• canal edema
• canal erythema
• otorrhea
• tenderness with movement of tragus or pinna
• often follows swimming or minor trauma from inappropriate cleaning

Question 4

risk factors for otitis externa

Answer 4

• swimming, esp fresh water
• skin conditions: eczema, seborrhea
• trauma from cerumen removal
• use of external devices (e.g. ear buds, hearing aids)
• cerumen buildup

Question 5

Dx of acute otitis externa

Answer 5

1. onset of symtpoms w/ 48 hours in past 3 weeks
2. one of the following SYMPTOMS of ear canal inflammation
   
   • ear pain, itching, fullness
   • w/ or w/o hearing loss or jaw pain
3. one of the following SIGNS of ear canal inflammation
   
   • tenderness of tragus/pinna or ear canal edema/erythema
   • w/ or w/o otorrhea, tympanic membrane erythema, cellulitis of the pinna, or local lymphadenitis

Question 6

advantage of using

neomycin/polymyxinB/hydrocortisone

for otitis externa

Answer 6

relatively cheap

Question 7

disadvantage of using

neomycin/polymyxinB/hydrocortisone

for otitis externa

Question 8

risks of using

neomycin/polymyxinB/hydrocortisone

for otitis externa

Answer 8

• ototoxic
• higher risk of contact hypersensitivity

Question 9

benefit of using

ofloxacin

or

ciprofloxacin/dexamethasone (Ciprodex)

for otitis externa

Answer 9

approved for middle ear use;

should be used if TM not intact or status cannot be determined visually

Question 10

how to administer otic medications

Answer 10

1. lay down with unaffected side up
2. run preparation along side of ear canal
3. remain in this position for 3-5 minutes
4. after this, do not occlud ear canal

with marked canal edema, a wick of compressed cellulose or ribbon gauze can be placed in canal to facilitate medication administration

Question 11

Pt asks why an opthalmic solution is prescribed for otitis externa. Explain.

Answer 11

some opthalmic solutions better tolerated than otic solutions due to differences in pH b/w preparations