Lecture 3 HEENT II - otitis media, etc. Cooper

Question 1

what is the GOLD STANDARD dx for otitis media (OM)?

Answer 1

Pneumatic otoscopy (must seal ear canal to do properly)

Question 2

acute or new otitis media definition

Answer 2

≤ 48 hours

Question 3

severe otitis media definition

Answer 3

toxic/sick appearing child, persistent otalgia (>48 hours, temperature ≥39oC (102.2oF) in the past 48 hours, or if there is uncertain access to follow-up

Question 4

middle ear effusion (MEE)

Answer 4

fluid behind the tympanic membrane

-NO SIGNS OF INFECTION

Question 5

acute otitis media (AOM) dx

Answer 5

• Moderate-severe bulging of the TM or otorrhea

- Mild bulging TM and recent ear pain or intense redness

Question 6

otitis media with effusion (OME)

Answer 6

• MEE without signs or symptoms of acute ear infection

- use: Tympanocentesis and Pneumatic otoscopy to dx

Question 7

what must you have to have AOM or OME?

Answer 7

FLUID!!!

-if no MEE, no AOM or OME

Question 8

Most common cause of AOM

Answer 8

strep pneumoniae

Question 9

2nd most common cause of AOM

Answer 9

H. influenza

Question 10

other causes of AOM

Answer 10

m. cat, viruses, ostiomeatal complex dysfxn

Question 11

OME (chronic OM) pathology

Answer 11

• Ostiomeatal complex/Eustachian tube dysfunction
• Sequelae of AOM (often AOM leads to OME)
• Viral
• Unknown
• Bacterial antigens
• Biofilm

Question 12

what is the best management for OME?

Answer 12

watchful waiting for children not at increased risk for speech, language, or learning problems (3 months from the date of effusion onset or dx)

Question 13

when do you reexamine child for OME?

Answer 13

3-6 month intervals until the effusion is no longer present if:

• No evidence of significant hearing loss
• No suspected structural abnormalities of the tympanic membrane (TM) or middle ear
• Do at 3-6 months intervals to make sure language is normal and hearing is normal

Question 14

management for OME

Answer 14

• tubes (help with drainage and to help children hear/develop language)
• surgery
• prednisone, antihistamines/decongestants

Question 15

what is NOT recommended by often given for OME management?

Answer 15

Prednisone oral or topical and antihistamines/decongestants

Question 16

types of surgery for OME management?

Answer 16

• Myringotomy with tympanostomy tube insertion
• Tympanocentesis (stick needle in and suck fluid out)
• Adenoidectomy

Question 17

if a child is ≤ to 6 months of age and present with AOM, is it severe or non-severe?

Answer 17

severe

Question 18

when do you give abx to pt with AOM?

Answer 18

if severe AOM and child is ≥ 6 months of age with moderate/severe signs OR symptoms OR temp ≥ 102.2F

Question 19

Non-severe AOM txt

Answer 19

• Abx or observe in 6-23 months if unilateral and IF AND ONLY IF you have good follow up
• Abx ≤ 24 months if bilateral
• Abx or observe if ≥ 24 months

Question 20

first choice treatment for AOM?

Answer 20

AMOXICILLIN

Question 21

alternate first choice txt for AOm if tubes present?

Answer 21

quinolone drops

-C/I in children!!!

Question 22

second choice txt for AOM?

Answer 22

Augmentin

Question 23

bactrim as txt for AOM

Answer 23

> 2 months, dosing based TMP component

-many allergic rxns and skin rxns

Question 24

cephalosporin for txt of AOM?

Answer 24

2nd or 3rd gen cephalosporins (cefpodoxime, cefuroxime, cefdinir)
-very good but more expensive

Question 25

DOC for txt of AOM in child who is vomiting and can’t keep down PO’s?

Answer 25

ceftriaxone IV

Question 26

what is the go to macrolide for txt of AOM?

Answer 26

azithromycin - it tastes good and don’t have to refrigerate

Question 27

why is it not common to give clindamycin for txt of AOM?

Answer 27

b/c it doesn’t taste good and is expensive

Question 28

pain relief for AOM

Answer 28

acetaminophen, ibuprofen, antipyrine/benzocaine

Question 29

what is NOT recommended to use for AOM pain relief?

Answer 29

topical decongestants

Question 30

can you use cold meds for AOM pain relief?

Answer 30

NO if < 2 y/o
Probs not if < 4 y/o
≥ 4 y/o, maybe

Question 31

AOM follow-up

Answer 31

improvement in 24-48 hours (After abx)

-MUST RE-EVALUATE in 2 weeks!!!!

Question 32

AOM ppx

Answer 32

• Pneumococcal vaccine
• Breast feeding (sucking part helps keep the Eustachian tube open)
• Smoke-free environment
• No bottles in bed
• Antibiotic prophylaxis – not recommended -> Amox sulfasoxazole

Question 33

TM perf occurs from?

Answer 33

• infection, trauma

- blows to ear, severe atmospheric overpressure, excessive water pressure, improper attempts at wax removal

Question 34

what to avoid in TM perf?

Answer 34

teardrops containing gentamicin, neomycin, tobramycin

THEY ARE OTOTOXIC

Question 35

what do you use to that TM perf if have otorrhea?

Answer 35

systemic antibiotics

Question 36

in-office txts of TM perf?

Answer 36

paper-patch method, a Gelfoam plug, fibrin glue

Question 37

surgical txt of TM perf?

Answer 37

tympanoplasty

Question 38

do most TM perfs heal by themselves?

Answer 38

YES

Question 39

when to refer for TM perf?

Answer 39

• > 2 months
• Significant hearing loss
• Ossicular trauma

Question 40

auricular hematoma results from?

Answer 40

direct trauma
“cauliflower ear”
-shearing forces - separation of anterior auricular perichondrium from the cartilage
-hematoma formation

Question 41

auricular hematoma txt?

Answer 41

if early identification treat in office by draining (needle, I&D)
-splints, compression

Question 42

Masoiditis txt

Answer 42

• Consult – must be admitted
• Medical – as with AOM
• Surgical