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Clinical Med I > HEENT - Ear Infections - Exam 2 > Flashcards

HEENT - Ear Infections - Exam 2 Flashcards

1
Q

What is another term for Otitis Externa?

A

Swimmer’s ear

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2
Q

What is the most common cause of Otitis Externa?

A

Bacteria (Pseudomonas and Staph)

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3
Q

What is the clinical presentation of Otitis Externa?

A
  • Otalgia (may be worse with movement of tragus)
  • Pruritis
  • Discharge
  • Erythematous and edematous EAC
  • Decreased hearing if marked swelling or significant discharge
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4
Q

If Otitis Externa is due to a pseudomonas infection, what color will the discharge be?

A

Green

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5
Q

If Otitis Externa is due to a staph infection, what color will the discharge be?

A

Yellow

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6
Q

If Otitis Externa is due to a fungal infection, what color will the discharge be?

A

White or black and fluffy like “bread mold”

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7
Q

What is the management of bacterial otitis externa?

A
  • Cortisporin Otic (avoid if suspected or known TM perforation)
  • Floxin Otic (indicated if there is a perforated TM)
  • Ciprodex or CiproHC
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8
Q

Are solutions or suspensions preferred for the treatment of otitis externa? Why?

A

Suspensions as they are less acidic than solutions and cause less irritation to infected tissues

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9
Q

What is the management of fungal otitis externa?

A
  • Clotrimazole 1% solution BID x 10-14 days (first-line)

- Meticulous cleaning of EAC

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10
Q

What is the management for severe otitis externa?

A

Referral to ENT for possible topical/oral antibiotic treatment and wick placement

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11
Q

In addition to the standard treatment, what should also be given to immunocompromised patient with severe otitis externa?

A

Oral antibiotics as they are at a greater risk for malignant otitis externa

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12
Q

How can one prevent otitis externa?

A
  • Prophylaxis with acidifying the EAC
  • Dry the EAC
  • Consider bathing cap or ear plugs if chronic problem
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13
Q

What is the expected course of otitis externa?

A
  • Resolution within 5-7 days

- Improvement of pain within 48-72 hours

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14
Q

What population is at the greatest risk of Malignant Otitis Externa?

A

Elderly diabetics

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15
Q

What is the clinical presentation of Malignant Otitis Externa?

A
  • Exquisite otalgia and otorrhea that is not responsive to typical OE treatment
  • Pain often nocturnal and with chewing
  • Red granulation tissue in the EAC
  • Possible periauricular lymphadenopathy, edema, trismus
  • Watch for possible CN involvement (indication of progressive osteomyelitis)
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16
Q

How can you diagnose malignant OE?

A
  • CT showing bone erosion

- Elevated ESR and CRP, indicating inflammation

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17
Q

What is the treatment for malignant OE?

A
  • Admit to hospital, culture of ear discharge
  • IV Ciprofloxacin
  • Possible surgical debridement
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18
Q

What is Otitis Media with Effusion (OME)?

A

Middle ear fluid without signs of illness or inflammation

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19
Q

What is the etiology for Otitis Media with Effusion (OME)?

A
  • Recent acute otitis media (most common)
  • URI/allergies
  • T tube dysfunction
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20
Q

What is the clinical presentation of Otitis Media with Effusion (OME)?

A
  • Ear fullness and decreased hearing
  • Painless
  • Amber-colored fluid behind TM
  • May see air-fluid levels and bubbles
  • Neutral or retracted TM
  • Tympanogram - Type B pattern
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21
Q

If an adult has persistent unilateral otitis media with effusion, would should you do?

A

Refer to ENT to rule out nasopharyngeal carcinoma

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22
Q

What is the management for otitis media with effusion?

A
  • Usually resolves spontaneously; “Watchful waiting”
  • T-tube placement
  • Intranasal steroids if underlying allergic rhinitis
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23
Q

When should you refer to ENT if patient presents with otitis media with effusion?

A
  • Persistent fluid and/or hearing loss > 3 months duration

- Children “at-risk” for speech, language or learning problems

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24
Q

What is the most common cause of eustachian tube dysfunction?

A

Obstruction due to inflammation or blockage that results in negative middle ear pressure and inability for fluid to drain out

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25
Q

If patient presents with eustachian tube dysfunction, what will be observed on exam?

A
  • Retracted TM

- Prominent bony landmarks

26
Q

How can you diagnose eustachian tube dysfunction?

A
  • Tympanogram Type C

- Clinical exam

27
Q

What is the treatment for eustachian tube dysfunction?

A
  • Steroid nasal spray
  • Management of allergies
  • Decongestants
  • T-tubes
28
Q

Why should you limit phenylephrine (Neo-synephrine) or Oxymetazoline (Afrin) use to only 3 days?

A

To avoid rebound congestion - “Rhinitis medicamentosa”

29
Q

What is the peak incidence age range for acute otitis media?

A

6-18 months

30
Q

What are the most common pathogens that contribute to acute otitis media (AOM)?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
31
Q

What is the clinical presentation of acute otitis media (AOM) in pediatric patients?

A
  • Ear pain (tugging on ear)
  • Irritability
  • Poor feeding
  • Fever
  • Hearing loss
32
Q

What is the clinical presentation of acute otitis media (AOM) in adult patients?

A
  • Otalgia

- Decreased hearing

33
Q

What are physical exam findings common with acute otitis media (AOM)?

A
  • Bulging TM
  • Erythema of TM
  • Poor mobility of TM
  • Otorrhea (ear discharge)
34
Q

What is Bullous Myringitis?

A

Inflammation of the TM with bulla formation that manifests 10-14 days after a viral infection

35
Q

When would you treat acute otitis media with antibiotics?

A
  • Child is less than 6 months old
  • moderate or severe otalgia
  • Otalgia > 48 hours
  • Temperature > or = to 102.2F (39C)
  • < 24 months old with bilateral acute otitis media
36
Q

If treating acute otitis media with antibiotics, what is the antibiotic of choice?

What is the dosage?

How long is it prescribed for?

A

Amoxicillin

90mg/kg/day divided by q 12 hours

Prescribed 7-10 days depending and age and complicating factors

37
Q

What is the 2nd line antibiotic choice for acute otitis media?

What class of drug is this?

A

Augmentin (Amoxicillin/clavulanate)

Beta-lactamase inhibitor

38
Q

When would you not prescribe Amoxicillin for acute otitis media?

A
  • Patient received it within 30 days
  • Patient has concurrent purulent conjunctivitis
  • Patient has a history of recurrent acute otitis media
  • Patient is allergic to penicillin
39
Q

If patient with acute otitis media is allergic to penicillin, what are alternative treatment options?

A

Mild-delayed reaction:

  • Oral cefdinir, cefuroxime, cefpodoxime
  • IM ceftriaxone

Immediate/Severe reaction:
- Azithromycin, clarithromycin, clindamycin

40
Q

If a patient returns for recurrent acute otitis media less than 15 days after successfully completing a treatment course, what should you prescribe?

A

Ceftriaxone

41
Q

If a patient returns for recurrent acute otitis media with 15-30 days after successfully completing a treatment course, what should you prescribe?

A

Augmentin

42
Q

When should Tympanostomy tubes be considered in cases of acute otitis media?

A
  • 3 or more episodes in past 6 months

- 4 or more episodes in past 12 months

43
Q

What are complications of acute otitis media?

A
  • Conductive hearing loss from persistent middle ear effusion (MEE)
  • TM perforation
  • Chronic otitis media
  • Tympanosclerosis
  • Cholesteatoma
  • Mastoiditis
  • Acute labyrinthitis
44
Q

What is tympanometry?

A

Quantitative measure of TM mobility

45
Q

Which type of tympanogram is normal?

A

Type A

46
Q

Which type of tympanogram is associated with little or no TM mobility?

A

Type B

47
Q

Which type of tympanogram is associated with retracted TM?

A

Type C

48
Q

How are TM perforations treated?

A

Most heal spontaneously in days to 1-2 weeks depending on size. If large enough, may require ENT referral for patch.

49
Q

What is chronic otitis media?

A

Drainage from the middle ear for 2 weeks or more with associated TM perforation that is usually painless

50
Q

What is the treatment for chronic otitis media?

A

Refer to ENT for patching and surgical debridement

51
Q

What is tympanosclerosis?

A

Scarring (white plaques) in the TM as a complication of frequent middle ear infections

52
Q

What are cholesteatomas?

A

Abnormal growth in a pocket of squamous epithelium in middle ear/mastoid

53
Q

Which are typical symptoms seen with mastoiditis?

A
  • Post-auricular pain, edema, and erythema
  • Fluctuance or mass
  • Fever
  • Deep temporal pain
  • Protrusion of pinna
54
Q

What is the treatment for mastoiditis?

A
  • IV antibiotics

- ENT referral for mastoidectomy

55
Q

What is mastoiditis a complication of?

A

Rare complication of acute otitis media

56
Q

What is the etiology of Labyrinthitis?

A

Preceding viral infection

57
Q

What is the clinical presentation of Labyrinthitis?

A
  • Acute onset of severe vertigo
  • Nausea and vomiting
  • Unilateral hearing loss
  • Head thrust (cannot maintain visual fixatio when head turned to affected side)
  • No CNS deficits
58
Q

What is the treatment for Labyrinthitis?

A

Treatment is symptomatic

59
Q

What is otitis externa caused by a fungal infection called?

A

Otomycosis

60
Q

If a wick is placed for treatment of otitis externa, how often should meds be applied and when should it be removed?

A
  • Apply medication TID - QID

- Remove wick after 48-72 hours and continue meds as directed

Clinical Med I (24 decks)

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