Lecture 3 - Otic Disorders Flashcards
predisposing factors to impact earwax?
narrow/deformed ear canals
Overactive glands
using hearing aids or earplugs
excessive hair growth in eternal auditory canal
age = drier
Male> females
signs and symptoms of impacted earwax
feeling of fullness, pain or itching in ear canal
ringing in ears
loss of hearing ~80% obstruction
How to prevent impacted earwax
clean outer ear regularly
clear ear devices regularly
irrigation + prophylactic cerumenolytic agents
Self-care exclusions for Otic disorders
signs of infection
Pain w/ ear discharge
bleeding or trauma
ruptured tympanic membrane
ear surgery w/I 6wks
Tympanostomy tubes
< 12 yrs old
Treatment for impacted earwax
Cerumenolytics
irrigation
manual removal
water-based cerumenolytics
Acetic acid 2.5%
Docusate sodium 10mg/ml
Hydrogen peroxide 3%
Sodium bicarb 10%
Sterile water or saline
Carbide peroxide admin
5-10 drops, let sit for 15min, flush w/ water water and make sure all drained
repeat 2X day for 4 days
Carbide peroxide ADE
Popping sounds on admin
Carbide peroxide counseling points
careful to not break tympanic membrane
if dizziness occur, contact HCP
Ear drop admin adults
wash hands
lie on side so affected ear facing up
pull auricle up and toward back of head, instill drops
Ear drop admin kids < 3
wash hands
lie on side so affected ear facing up
gently pull earlobe down toward the back of the head, instill drops
earwax removal
irrigation or manual removal (by trained professional)
what to avoid for earwax removal
using cotton swabs or ear candling
predisposing factors to water-clogged ears
shape of ear canal
excessive earwax
swimming
excessive sweating
humid climates
signs and symptoms of water-clogged ears
feeling of wetness or fullness in ear
gradual hearing loss
not usually painful
non-pharm treatment for water-clogged ears
tilt head to side
lie down w/ affected ear facing down
chew/yawn
hair dryer on low setting
swim-EAR
isopropyl alcohol 95% in anhydrous Glycerin 5%
safe/effective
use after shower, swim, bath, washing hair
swim-EAR MOA
alcohol mixes w/ water and help dry canal, >70% can act as disinfectant
swim-EAR ADE
Generally well tolerated
can cause stinging if skin is broken
swim-EAR admin
instill 4-5drops into open ear canal
let sit for 30sec-1min
tilt head to side and let it drain out
Risk factors to swimmers ear
High humidity
warmer temp
maceration of skin
local trauma to external ear
exposure to water that is high in bacteria
signs and symptoms of swimmers ear
rapid onset
severe ear pain
itching
fullness
prevention of swimmers ear
using ear plugs
dry ear after swimming
tilt head to remove water
swimmers ear usually treated with….
topical antimicrobials, 7-10 day treatment
If ruptured tympanic membrane, you want to use…
Fluoroqinolones
what should be avoided for ruptured tympanic membrane
Cipro-HC
avoid aminoglycosides
topical antimicrobail fluoroquinolones
cipro 0.2/0.3%
cipro 0.3%/dex 0.1%
Cipro 0.2%/hydrocort 0.1% = no use rupture
Ofloxacin 0.3%
swimmers ear non-pharm treatment
minimuze trauma to/manipulation f ear
avoid water submersion for 1 week
use ear plug when shower
dry canal after showering
Analgesics preferred for swimmers ear?
Oral preferred, scheduled instead of PRN….48-72hrs worth
are oral antibiotics used for swimmers ear?
not really, dont need to use
who can recieve oral antibiotics for swimmers ear?
Altered immune function
prior radiation
Tympanostomy tubes or perforated TM
acute otitis media is…
ear infection
risk factor for ear infection
day care
siblings in home
lack of breast feeding
exposure to tobacco smoke
lower socioeconomic status
use of pacifier
anatomic abnormalities
most common causes ear infection
viruses
Strep. pneum
H.influ
M.ctarrhalis
diagnosis of ear infection
rapid onset of pain
presence of middle ear effusion (MEE)
severe ear infection
Moderare or sever pain for > 48hrs
or temp >39 or 102
non-severe ear infection
mild pin for < 48hrs
and temp < 39C or 102
6-23 months, non-severe unilateral
observe or 10 days ABX
2-5yrs, non-severe bilateral or unilateral
observe or 7 days ABX
> 6yrs, non-severe bilateral or unilateral
Observe or 5-7days ABX
1st line therapy for initial immediate or delayed therapy Ear infection
High dose Amox = 80-90mg/kg/day BID
or
Amox/clav = 90mg/kg/day amox + 6.4mg/kg/day clav BID
alternative medications for ear infection if PCN allergy
Cefdinir
Cefuroxime
Cefpodoxime
Ceftriaxone
1st line if antibiotic treatment failed for ear infection
Amox/clav = 90/6.4 mg/kd/day BID
or
Ceftriaxone 50mg/kg/day IM/IV 3 days
alternative if failed 2nd ABX for ear infection
Clindamycin 30-40mg/kg/day PO TID w/ or w/o 3rd gen cephalosporin
why use watchful waiting
normal clinical course of AOM= can resolve alone
ADEs associated w/ ABX
Proper use of analgesics
Followup plan if sx done improve
prevention of AOM
immunizations - Prevnar, pneumovax, flu
breastfeeding = least 6 months
avoid tobacco smoke
Most common cause acute bacterial rhino sinusitis (ABRS)
strep pneumo
H. influ
M.catrrhalis
symptoms of sinusitis
Key = discolored discharge
sinus pressure/pain
post-nasal drip
sore throat
toothache
cough
headache
fatigue
Diagnosis of ABRS
> 10 days symptoms
Fever >39 + discharge/pain
worsening = new onset of fever/HA, inc nasal drainage
ABRS 1st line children
Amox/clav 45mg/kg/day BID 10-14 days
ABRS 2nd line children
Amox/clav 90mg/kg/day BID 10-14days
ABRS B-Lactam allergy Type 1 children
levo 10-20mg/kg/day q12-24hrs
ABRS B-lactam alelrgy Non-type 1 children
Clindamyxin 30-40mg/kg/day TID + cefixime or cefpodoxime
Severe infection req hospital ABRS children
IV Ceftriaxone or ampicillin/sulbactam
2nd = Cefotaxime or Levoflox IV
ABRS 1st line adult
Amox/clav 500/125 TID or 875/125 BID 5-7days
ABRS 1st line adult B-lactam allergy
Doxy 100mg PO BID 5-7days
ABRS 1st line adult severe infection req hospital
Ceftriaxone 1-2g IV q12/24hrs
Ampicillin/sulbactam 1.5-3g IV q6h
ABRS 2nd line adult
amoxicillin/clav 2000/125 PO BID
Doxy 100mg PO BID
ABRS 2nd line adult B-lactam allergy
Levo 500mg PO QD
Moxiflox 400 PO QD
ABRS 2nd line severe infection
Levo 500 PO or IV QD
Moxiflox 400 PO or IV QD
Who gets High dose Amox/Clav for ABRS
high endemic rates >10% of pen non-sus S.pneum
Severe infection ( systemic toxicity, > 39C)
attend daycare
Age < 2 or > 65
Recent hospitalization w/I 5 days
ABX use in last month
immunocompromised or comorbid conditions
