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X Clin Med Exam 2 > L10 Ear Infections > Flashcards

L10 Ear Infections Flashcards

1
Q

Why are infants more likely to get ear infections?

A

Their eustachian tube is more horizontal (nose to ear drainage)

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2
Q

“Swimmers ear”

A

otitis externa

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3
Q

Cause of otitis externa

A

heat/moisture leads to swelling and maceration of EAC allowing bacteria to enter, trauma, skin diseases (eczema, psoriasis, seborrheic dermatitis)

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4
Q

Etiology of Otitis Externa

A

Bacterial (most common) or fungal

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5
Q

Bacteria causing otitis externa

A

pseudomonas aeruginosa (38%), staph epidermidis (9%), staph aureus (8%)

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6
Q

Fungus causing otitis externa

A

Asperigillus niger or Candida albicans

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7
Q

Clinical presentation of otitis externa

A

ostalgia (worse with movement of tragus and pinna), pruritus (mild/severe), discharge, EAC may be erythematous and edematous, decreased hearing or swelling (conductive due to d/c or swelling)

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8
Q

Yellow discharge with OE

A

staph infection

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9
Q

Green discharge with OE

A

pseudomonas infection

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10
Q

Fluffy white/black “bread mold” discharge with OE

A

fungal infection

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11
Q

Otomycosis

A

fungal OE

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12
Q

Tx for OE

A

Cortisporin otic suspension (polymixin B, neomycin, hydrocortison), Floxin otic solution (ofloxacin), ciprodex or CiproHC (ciprofloxacin + glucocorticoid)

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13
Q

First line treatment for OE

A

Cortisporin otic solution

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14
Q

Treatment of OE with perforated TM

A

floxin otic solution (ofloxacin)

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15
Q

Side effects of Cortisporin otic solution

A

allergic rxn.- contact dermatitis, DON’T USE WITH TM PERFORATION

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16
Q

Why are otic suspensions better than solution?

A

less acidic (pH 5 vs. pH 3.4), so less irritation to infected tissues

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17
Q

Tx for fungal OE

A

Clotrimazole 1% solution (BID x 14 days), Acidifying solution (acetic acid)

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18
Q

Tx for marked swelling in EAC

A

ear wick (Oto-wick)- apply medication to wick TID-QID; remove wick after 48-72 hours and continue meds as directed

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19
Q

Management of OE

A

pain control, keep canal dry (no swimming 7-10d, cotton in ear when bathing)

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20
Q

How soon do OE usually resolve

A

5-7 days

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21
Q

If no improvement of OE in 48-72 hours what do you consider?

A

noncompliance, otomycosis, periauricular cellulitis, or malignant otits externa

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22
Q

Prevention of OE

A

prophylaxis: 2% acetic acid (Vosol), vinegar soluiton, isopropyl alcohol or hair dryer; bathing cap or custom ear plugs

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23
Q

Malignant OE

A

necrotizing external otitis

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24
Q

Cause of MOE

A

infection spreads from skin of EAC to skull base (pseudomonas)

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25
Q

Who is most at risk for MOE

A

elderly diabetics & immunocompromised patients

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26
Q

Clinical presentation of MOE

A

otalgia and otorrhea not responsive to OE tx; pain nocturnal and with chewing; red granulation tissue in EAC; possible periauricular lymphadenopathy, edem and trismus; watch for CN involvement (indication of progressive osteomyelitis)

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27
Q

Dx of MOE

A

CT!!! (bone erosion), ESR and CRP elevated; MRI

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28
Q

Tx of MEO

A

ADMIT, C&S of ear discharge, IV Ciprofloxacin, possible debridement

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29
Q

Complications of MOE

A

intracranial spread leading to meningitis, brain abscess and sepsis; mortality 10-20%

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30
Q

OME

A

otitis media w/ effusion

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31
Q

other names of OME

A

serous, secretory or nonsuppurative OM

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32
Q

Middle ear effusion in the absence of acute sxs

A

Otitis Media w/ Effusion

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33
Q

acute illness with middle ear fluid and s/sx of middle ear inflammation

A

Acute otitis media (AOM, suppurative otitis media)

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34
Q

Chronic infection of middle ear with non-intact TM and otorrhea

A

Chronic otitis media

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35
Q

Sx of OME

A

ear fullness and decreased hearing; usually painless

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36
Q

Etiology of OME

A

recent AOM, URIs, allergies, eustachian tube dysfunction, barotrauma, or nasopharyngeal carinoma

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37
Q

Clinical presentation of OME

A

patient afebrile, amber-colored (straw) fluid behind TM, air-fluid levels and bubbles, neutral or retracted TM; possible conductive hearing loss, TM not moving with pneumatic otoscopy, Tympanogram (Type B Pattern)

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38
Q

Recurrent OME could be a sign of what

A

nasopharyngeal carcinoma - REFER TO ENT TO RULE OUT

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39
Q

Type B tympanogram

A

little to no movement of TM; suggests OME

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40
Q

Tx of OME

A

usually resolves spontaneously, re-evaluate in 4-6 weeks (“watchful waiting,” intranasal steroids if underlying allergic rhinitis; refer to ENT for tympanostomy “T-tubes” if: persistent fluid and/or hearing loss >3 months, child considered at risk for speech, language or learning problems

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41
Q

inflammation or blockage resulting in negative middle ear pressure

A

eustachian tube dysfunction

42
Q

Sx of eustachian tube dysfunction

A

ear fullness, recurrent OME, hearing loss

43
Q

Exam findings for eustachian tube dysfunction

A

retracted TM, prominent bony landmarks

44
Q

Dx for eustachian tube dysfunction

A

clinical, tympanogram type C

45
Q

Tympanogram type C

A

middle ear with negative pressure; eustachian tube dysfunction

46
Q

Cause of eustachian tube dysfunction

A

inflammation or blockage

47
Q

Tx of eustachian tube dysfunction

A

steroid nasal spray, management of allergies, decongestants, T-tubes; may use topical decongestants (phenylephrine or Afrin)- limit therapy to 3 days to avoid rebound congestions (Rhinitis medicamentosa)

48
Q

Topical nasal decongestants

A

phenylephrine (neo-synephrine) or oxymetazoline (afrin)

49
Q

AOM most common in

A

pediatrics (peak: 6-18 mo)

50
Q

URI usually precipitates

A

AOM

51
Q

Cause of AOM

A

eustachian tube becomes obstructed w/ fluid and mucus; becomes secondarily infected; mastoid air cells involved

52
Q

Most common etiology of AOM

A

stretpococcus pneumoniae (50%), haeomphilus influenzae (40%), moraxella catarrhalis (10%)

53
Q

Other pathogens causing AOM

A

strep pyogenes, strep viridans, staph aureus, pseudomonas aeuroginosa, viruses (RSC)

54
Q

Risk Factors of AOM

A

young age/immature anatomy (horizontal eustachian tube, enlarged adenoids preventing drainage), second hand smoke, lack of breastfeeding, day care, use of pacifier, season (fall/winter)

55
Q

Pediatric Clinical presentation of AOM

A

irritability/restless sleep, poor feeding/anorexia, fever, ear pain (tugging on ear), hearing loss/ear fullness

56
Q

Associated sx with AOM

A

conjunctivitis, rhinorrhea, ear discharge, vomiting, diarrhea

57
Q

Adult presentation of AOM

A

otalgia and decreased hearing; fever is rare

58
Q

PE findings in AOM

A

TM bulging (distorted, loss of landmarks), signs of inflammation (reddening, purulent middle ear effusion), poor mobility (pneumatic otoscopy)

59
Q

Standard of car in dx of AOM

A

pneumatic otoscopy- detects poor mobility of TM

60
Q

Bullous myringitis

A

inflammation of the TM w/ bulla formation

61
Q

Cause of bullous myringitis

A

manifests in 10-14 days after viral infection (mycoplasma pneumoniae)

62
Q

Sx of bullous myringitis

A

sever localized ostalgia

63
Q

Dx of AOM in children 6 mo - 12 years

A

moderate to severe bulging of TM, new onset of otorrhea not due to acute OE, mild bulging of TM and ear pain (<48 hrs) or intense erythema of TM; pneumatic otoscopy, tympanometry

64
Q

Type A tympanogram

A

normal ear; pressure at 0, compliance normal

65
Q

Type B tympanogram

A

little or no mobility; fluid or TM perforation; flat line

66
Q

Type C

A

Retracted TM; eustachian tube dysfucntion; negative pressure

67
Q

When to tx AOM w/ Abx

A

<6 mo, >6 mo: bilateral or unilateral AOM w/ severe signs or symptoms, non-severe, bilateral AOM in ages 6-24 mo

68
Q

observation and follow up in 48-72 hours for AOM w/o abx if;

A

6-23 mo: unilateral AOM w/o severe s/sx

>24 mo: without sever s/sx

69
Q

Sever s/sx of AOM

A

moderate/severe otalgia, otalgia for at least 48 hours, fever (102.2/39) or higher

70
Q

Tx of AOM

A

amoxicillin (high dose): 90 mg/kg/day divided q 12 hours (max dose of 3g/day) x 7-10 days

71
Q

When not to use amoxicillin for AOM

A

high risk for resistant organism (received abx in last 30 days, have concurrent purulent conjunctivitis (H.influenzae), hx of recurrent AOM resistant to amoxicillin)

72
Q

2nd line tx for AOM (resistant organism)

A

Augmentin

73
Q

Augmentin is composed of

A

amoxicillin and clavulanate

74
Q

Augmentin dosage

A

90 mg/kg amoxicillin and 6.4 mg/kg clavulanate

75
Q

Alternative tx for AOM

A

used if PCN allergy or tx failure

76
Q

What are alternative tx for AOM

A

Oral: omnicef, ceftin, vantin, zithromax (only for severe PCN allerge, not for tx failure)
IM/IV: rocephin 50 mg IM or IV daily x 1-3 days

77
Q

Tx duration for AOM

A

10 days if: <2 years old, AOM w/ TM rupture, hx of recurrent AOM
5-7 days if: >2 yo w/o TM rupture or hx of recurrent infection

78
Q

Other tx of AOM

A

abx, sx tx of pain/fever (acetaminophen or ibuprofen), encourage oral fluids: NO VALUE of using decongestants or antihistamines (unless allergies), OTC cold preps NOT used in children <4 yo

79
Q

Persistant/worseing of AOM after 48-72 hrs

A

repeat PE, initiate or change abx; if sx persist despite appropriate abx, consider IM Rocephin or refer to ENT for tympanocentesis

80
Q

AOM patient education

A

pain/fever resolve after 3 days (if not, RTC for eval); recheck @ 7-14 days, hearing loss may take up to a month to resolve

81
Q

Recurrent AOM

A

development of s/s of AOM soon after completion of successful tx

82
Q

Tx for recurrent AOM

A

Rocephin

83
Q

When to consider tympanostomy tubes

A

3 or more AOM in 6 mo,

>4 episodes of AOM in 12 mo.

84
Q

complications of AOM

A

infratemporal: TM perforation, tympanosclerosis, chronic OM, mastoiditis, hearing loss, cholesteatoma, acute labyrinthitis
intracranial: meningitis, encepahlitis, brain abscess
Systemic: bacteremia

85
Q

Chronic otitis media

A

drainage from middle ear >2 weeks and associated TM perforation that is painless

86
Q

Etiology of chronic otitis media

A

recurrent AOM, trauma, or cholesteatoma; pseudomonas, MRSA

87
Q

Sx of Chronic otitis media

A

conductive hearing loss

88
Q

Tx for chronic otitis media

A

Refer to ENT

89
Q

TM perforations

A

associated with acute/chronic OM

90
Q

Sx of TM perforation

A

+/- pain, otorrhea, conductive hearing loss, no movement w/ pneumatic otoscopy, vertigo indicative of injury to inner ear, most heal spontaneously

91
Q

Keratinized, desquamated epithelia collection in middle ear or mastoid

A

cholesteatoma

92
Q

Mastoiditis

A

rare complication of AOM, post-auricular pain, edema and erythema; fluctuance or mass, fever, deep temporal pain, protrusion of pinna

93
Q

Tx for mastoiditis

A

IV abx; ENT consult (mastoidectomy)

94
Q

Mastoidectomy

A

removing diseased mastoid air cells

95
Q

Labyrinthitis (vestibular neuritis/neuronitis)

A

benign, acute inflammation or infection of the vestibular system

96
Q

Pure vestibular neuritis

A

hearing preserved

97
Q

Labyrinthitis

A

unilateral hearing loss present

98
Q

Cause of labyrinthitis

A

viral infections (URI); AOM or meningitis

99
Q

Clinical presentation of labyrinthitis

A

acute onset of severe vertigo (1-2 days), N/V, gait instability, unilateral hearing loss, horizontal nystagmus, (+) head thrust (can’t maintain visual fixation), No CNS deficits

100
Q

(+) Head thrust

A

unable to fixate vision on object when head is turned, eyes move with head the quickly saccade back to target; (+) finding = peripheral vestibular lesion (turn head to right/effected ear is the right, vice-versa)

101
Q

Tx of labyrinthitis

A

symptomatic (bed rest, hydration, oral prednisone taper); antihistamines/anticholergics (Meclizine (Antivert 25 mg TID); antiemetics (compazine); benzodiazepines (valium, ativan) - least preferred due to sedation

102
Q

“popping” in ears

A

OME/SOM

X Clin Med Exam 2 (6 decks)

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