HEENT - Ear Infections - Exam 2 Flashcards
What is another term for Otitis Externa?
Swimmer’s ear
What is the most common cause of Otitis Externa?
Bacteria (Pseudomonas and Staph)
What is the clinical presentation of Otitis Externa?
- Otalgia (may be worse with movement of tragus)
- Pruritis
- Discharge
- Erythematous and edematous EAC
- Decreased hearing if marked swelling or significant discharge
If Otitis Externa is due to a pseudomonas infection, what color will the discharge be?
Green
If Otitis Externa is due to a staph infection, what color will the discharge be?
Yellow
If Otitis Externa is due to a fungal infection, what color will the discharge be?
White or black and fluffy like “bread mold”
What is the management of bacterial otitis externa?
- Cortisporin Otic (avoid if suspected or known TM perforation)
- Floxin Otic (indicated if there is a perforated TM)
- Ciprodex or CiproHC
Are solutions or suspensions preferred for the treatment of otitis externa? Why?
Suspensions as they are less acidic than solutions and cause less irritation to infected tissues
What is the management of fungal otitis externa?
- Clotrimazole 1% solution BID x 10-14 days (first-line)
- Meticulous cleaning of EAC
What is the management for severe otitis externa?
Referral to ENT for possible topical/oral antibiotic treatment and wick placement
In addition to the standard treatment, what should also be given to immunocompromised patient with severe otitis externa?
Oral antibiotics as they are at a greater risk for malignant otitis externa
How can one prevent otitis externa?
- Prophylaxis with acidifying the EAC
- Dry the EAC
- Consider bathing cap or ear plugs if chronic problem
What is the expected course of otitis externa?
- Resolution within 5-7 days
- Improvement of pain within 48-72 hours
What population is at the greatest risk of Malignant Otitis Externa?
Elderly diabetics
What is the clinical presentation of Malignant Otitis Externa?
- 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)
How can you diagnose malignant OE?
- CT showing bone erosion
- Elevated ESR and CRP, indicating inflammation
What is the treatment for malignant OE?
- Admit to hospital, culture of ear discharge
- IV Ciprofloxacin
- Possible surgical debridement
What is Otitis Media with Effusion (OME)?
Middle ear fluid without signs of illness or inflammation
What is the etiology for Otitis Media with Effusion (OME)?
- Recent acute otitis media (most common)
- URI/allergies
- T tube dysfunction
What is the clinical presentation of Otitis Media with Effusion (OME)?
- 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
If an adult has persistent unilateral otitis media with effusion, would should you do?
Refer to ENT to rule out nasopharyngeal carcinoma
What is the management for otitis media with effusion?
- Usually resolves spontaneously; “Watchful waiting”
- T-tube placement
- Intranasal steroids if underlying allergic rhinitis
When should you refer to ENT if patient presents with otitis media with effusion?
- Persistent fluid and/or hearing loss > 3 months duration
- Children “at-risk” for speech, language or learning problems
What is the most common cause of eustachian tube dysfunction?
Obstruction due to inflammation or blockage that results in negative middle ear pressure and inability for fluid to drain out
If patient presents with eustachian tube dysfunction, what will be observed on exam?
- Retracted TM
- Prominent bony landmarks
How can you diagnose eustachian tube dysfunction?
- Tympanogram Type C
- Clinical exam
What is the treatment for eustachian tube dysfunction?
- Steroid nasal spray
- Management of allergies
- Decongestants
- T-tubes
Why should you limit phenylephrine (Neo-synephrine) or Oxymetazoline (Afrin) use to only 3 days?
To avoid rebound congestion - “Rhinitis medicamentosa”
What is the peak incidence age range for acute otitis media?
6-18 months
What are the most common pathogens that contribute to acute otitis media (AOM)?
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
What is the clinical presentation of acute otitis media (AOM) in pediatric patients?
- Ear pain (tugging on ear)
- Irritability
- Poor feeding
- Fever
- Hearing loss
What is the clinical presentation of acute otitis media (AOM) in adult patients?
- Otalgia
- Decreased hearing
What are physical exam findings common with acute otitis media (AOM)?
- Bulging TM
- Erythema of TM
- Poor mobility of TM
- Otorrhea (ear discharge)
What is Bullous Myringitis?
Inflammation of the TM with bulla formation that manifests 10-14 days after a viral infection
When would you treat acute otitis media with antibiotics?
- 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
If treating acute otitis media with antibiotics, what is the antibiotic of choice?
What is the dosage?
How long is it prescribed for?
Amoxicillin
90mg/kg/day divided by q 12 hours
Prescribed 7-10 days depending and age and complicating factors
What is the 2nd line antibiotic choice for acute otitis media?
What class of drug is this?
Augmentin (Amoxicillin/clavulanate)
Beta-lactamase inhibitor
When would you not prescribe Amoxicillin for acute otitis media?
- 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
If patient with acute otitis media is allergic to penicillin, what are alternative treatment options?
Mild-delayed reaction:
- Oral cefdinir, cefuroxime, cefpodoxime
- IM ceftriaxone
Immediate/Severe reaction:
- Azithromycin, clarithromycin, clindamycin
If a patient returns for recurrent acute otitis media less than 15 days after successfully completing a treatment course, what should you prescribe?
Ceftriaxone
If a patient returns for recurrent acute otitis media with 15-30 days after successfully completing a treatment course, what should you prescribe?
Augmentin
When should Tympanostomy tubes be considered in cases of acute otitis media?
- 3 or more episodes in past 6 months
- 4 or more episodes in past 12 months
What are complications of acute otitis media?
- Conductive hearing loss from persistent middle ear effusion (MEE)
- TM perforation
- Chronic otitis media
- Tympanosclerosis
- Cholesteatoma
- Mastoiditis
- Acute labyrinthitis
What is tympanometry?
Quantitative measure of TM mobility
Which type of tympanogram is normal?
Type A
Which type of tympanogram is associated with little or no TM mobility?
Type B
Which type of tympanogram is associated with retracted TM?
Type C
How are TM perforations treated?
Most heal spontaneously in days to 1-2 weeks depending on size. If large enough, may require ENT referral for patch.
What is chronic otitis media?
Drainage from the middle ear for 2 weeks or more with associated TM perforation that is usually painless
What is the treatment for chronic otitis media?
Refer to ENT for patching and surgical debridement
What is tympanosclerosis?
Scarring (white plaques) in the TM as a complication of frequent middle ear infections
What are cholesteatomas?
Abnormal growth in a pocket of squamous epithelium in middle ear/mastoid
Which are typical symptoms seen with mastoiditis?
- Post-auricular pain, edema, and erythema
- Fluctuance or mass
- Fever
- Deep temporal pain
- Protrusion of pinna
What is the treatment for mastoiditis?
- IV antibiotics
- ENT referral for mastoidectomy
What is mastoiditis a complication of?
Rare complication of acute otitis media
What is the etiology of Labyrinthitis?
Preceding viral infection
What is the clinical presentation of Labyrinthitis?
- 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
What is the treatment for Labyrinthitis?
Treatment is symptomatic
What is otitis externa caused by a fungal infection called?
Otomycosis
If a wick is placed for treatment of otitis externa, how often should meds be applied and when should it be removed?
- Apply medication TID - QID
- Remove wick after 48-72 hours and continue meds as directed
