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2017 EENT Clin Med Group > Middle Ear-Basic and Advanced COPY > Flashcards

Middle Ear-Basic and Advanced COPY Flashcards

1
Q

Hearing pathway

A
  1. Sound enters ear
  2. Tiny middle ear bones amplify sound
  3. Cochlea sorts sounds by frequency
  4. Nerve passes signal from cochlea to brain stem
  5. Signal travels through brain getting decoded along the way
  6. Auditory cortex recognizes, processes sound
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2
Q

Pathophysiology of Acute Otitis Media

  • Viral Infection
A

Viral infection

  • Eustachian tube swelling results in decrease in equalization between middle ear and atmospheric pressure
  • Build up of mucus in middle ear
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3
Q

Pathophysiology of Acute Otitis Media

  • Bacterial Infection
A

Bacterial infection

  • Bacterial overgrowth in middle ear
  • Spread of bacterial infection throughout middle ear and mastoid air cells
  • Immune response will result in WBC invasion and pus formation
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4
Q

Acute Otitis Media

Identify the bacteria in a:

  • Patient <3 months
A

Patient <3 months

  1. E. Coli
  2. Staph Aureus

______________________

Patient 3 months-14 years

  1. Strep pneumoniae
  2. H influenzae
  3. M catarrhalis

Patient >14 years

  1. Strep pneumoniae
  2. Group A-hemolytic strep (GAS)
  3. Staph Aureus
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5
Q

Acute Otitis Media

Identify the bacteria in a:

  • Patient 3 months-14 years
A

Patient 3 months-14 years

  1. Strep pneumoniae
  2. H influenzae
  3. M catarrhalis

______________________

Patient <3 months

  1. E. Coli
  2. Staph Aureus

Patient >14 years

  1. Strep pneumoniae
  2. Group A-hemolytic strep (GAS)
  3. Staph Aureus
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6
Q

Acute Otitis Media

Identify the bacteria in a:

  • Patient > 14 years
A

Patient >14 years

  1. Strep pneumoniae
  2. Group A-hemolytic strep (GAS)
  3. Staph Aureus

______________________

Patient <3 months

  1. E. Coli
  2. Staph Aureus

Patient 3 months-14 years

  1. Strep pneumoniae
  2. H influenzae
  3. M catarrhalis
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7
Q

What is the peak incidence of Acute Otitis Media?

A

Peak incidence between 6-18 months old

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8
Q

Which vaccines are responsible for the decline in Acute Otitis Media?

A

PCV7 and PCV13

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9
Q

What are the risk factors of Acute Otitis Media?

A

Risk Factors

Note: Peak incidence between 6-18 months old

  1. Family history (immediate and remote)
  2. Day Care
  3. Exposure to tobacco smoke/air pollution

_________________________

Clinical presentation

  1. Headache
  2. Apathy
  3. Otalgia (ear pain)
  4. +/- Otorrhea (ear discharge)
  5. Fever
  6. Irritability
  7. Disturbed/restless sleep
  8. Poor feeding

Physical exam

  • Gold standard: Pneumatic Otoscopy
  • Affected ear: Decreased hearing, lateralization to affected ear, BC>AC
  • Otoscope exam:
    • Color: pearly gray (normal) or pink/light red (consistent with otitis media)
    • Position: neutral, retracted (common with ETD or effusion), bulging (indication of pus)
    • Mobility: brisk, none, slight movement? (expect no movement and slight movement)
    • Perforation: intact, single perforation, multiple?

Physical Exam-Evidence of current or recent URI

  • Scleral injection
  • Coryza
  • Pharyngeal erythema
  • Tonsillar swelling
  • Cervical lymphadenopathy
  • Skin rashes
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10
Q

What are the four diagnosis criteria for Acute Otitis Media in 6 months-12 year olds?

A
  1. New onset of otorrhea (not due to acute otitis externa); OR
  2. moderate-severe bulging of TM; OR
  3. mild bulging of TM AND recent otalgia; OR
  4. mild bulding of TM AND intense erythema of TM
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11
Q

What is the clinical presentation of Acute Otitis Media?

A

Clinical presentation

  1. Headache
  2. Apathy
  3. Otalgia (ear pain)
  4. +/- Otorrhea (ear discharge)
  5. Fever
  6. Irritability
  7. Disturbed/restless sleep
  8. Poor feeding

_________________________

Risk Factors

Note: Peak incidence between 6-18 months old

  1. Family history (immediate and remote)
  2. Day Care
  3. Exposure to tobacco smoke/air pollution

Physical exam

  • Gold standard: Pneumatic Otoscopy
  • Affected ear: Decreased hearing, lateralization to affected ear, BC>AC
  • Otoscope exam:
    • Color: pearly gray (normal) or pink/light red (consistent with otitis media)
    • Position: neutral, retracted (common with ETD or effusion), bulging (indication of pus)
    • Mobility: brisk, none, slight movement? (expect no movement and slight movement)
    • Perforation: intact, single perforation, multiple?

Physical Exam-Evidence of current or recent URI

  • Scleral injection
  • Coryza
  • Pharyngeal erythema
  • Tonsillar swelling
  • Cervical lymphadenopathy
  • Skin rashes
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12
Q

What is the physical exam presentation of Acute Otitis Media?

A

Physical exam

  • Gold standard: Pneumatic Otoscopy
  • Affected ear: Decreased hearing, lateralization to affected ear, BC>AC
  • Otoscope exam:
    • Color: pearly gray (normal) or pink/light red (consistent with otitis media)
    • Position: neutral, retracted (common with ETD or effusion), bulging (indication of pus)
    • Mobility: brisk, none, slight movement? (expect no movement and slight movement)
    • Perforation: intact, single perforation, multiple?

Physical Exam-Evidence of current or recent URI

  • Scleral injection
  • Coryza
  • Pharyngeal erythema
  • Tonsillar swelling
  • Cervical lymphadenopathy
  • Skin rashes

_________________________

Risk Factors

Note: Peak incidence between 6-18 months old

  1. Family history (immediate and remote)
  2. Day Care
  3. Exposure to tobacco smoke/air pollution

Clinical presentation

  1. Headache
  2. Apathy
  3. Otalgia (ear pain)
  4. +/- Otorrhea (ear discharge)
  5. Fever
  6. Irritability
  7. Disturbed/restless sleep
  8. Poor feeding
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13
Q

What other differential diagnoses should be on your list if you suspect Acute Otitis Media?

A
  1. Otitis externa
  2. Sinusitis
  3. Otitis media with effusion
  4. Eustachian tube dysfunction
  5. Cholesteatoma
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14
Q

Are any diagnostic studies required for Acute Otitis Media?

A

none; clinical diagnosis

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15
Q

Treatment of Acute Otitis Media

What are the 3 “severe” symptoms in deciding treatment?

A
  1. Temperature >39 degrees C (102.2 F)
  2. Otalgia > 48hrs
  3. Moderate or severe otalgia
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16
Q

Treatment of Acute Otitis Media

6 months-23 months

and

How do you reduce pain?

A
  • Reduce pain with analgesics (acetaminophen) and anti-inflammatories (ibuprofen)
17
Q

Treatment of Acute Otitis Media

Greater than/equal to 24 months

and

How do you reduce pain?

A
  • Reduce pain with analgesics (acetaminophen) and anti-inflammatories (ibuprofen)
18
Q

Treatment of Acute Otitis Media

Antiobiotics: Give first line, second line, and third line

and

How do you reduce pain?

A

First Line

Amoxicillin or Amoxicillin clavulanate (augmentin)

Second Line

Cefdinir or Cefuroxime

Third Line

Azithromycin (Z-pak) or Ceftriaxone

  • Reduce pain with analgesics (acetaminophen) and anti-inflammatories (ibuprofen)
19
Q

Acute otitis media

You have diagnosed your patient that is under 2 years old with acute otitis media. What is the follow up care?

A

Bring patient back in 8-12 weeks; look for Otitis Media w/Effusion

20
Q

Acute otitis media

You have diagnosed your patient that is 2 years old or older with learning/language problems with acute otitis media. What is the follow up care?

A

Bring patient back in 8-12 weeks; look for Otitis Media w/Effusion

21
Q

Acute otitis media

You have diagnosed your patient that is 2 years old or older with NO learning/language problems with acute otitis media. What is the follow up care?

A

No follow up necessary

22
Q

Acute Otitis Media

You have diagnosed a patient with acute otitis media. What should you educate the patient about?

A

Inform patient to return to clinic/reach out if:

  1. TM rupture
  2. Symptoms worsen or persist beyond 48-72 hrs after initial visit
  3. Red flag: Erythematous swelling behind affected ear
  4. Red flag: spread to both ears in infant
  5. Red flag: Persistant high grade fever (>103 F)
23
Q

Acute Otitis Media

Patient has been diagnosed with acute otitis media. What are 4 complications you might be worried about?

A
  1. Mastoiditis: infection of mastoid air cells (direct extension of middle ear)
  2. Bullous Myringitis: painful blister/bulla formation on the TM
  3. Recurrent infection: An infection that returns within 15 days of completion of treatment
  4. Chronic otitis media
24
Q

Acute Otitis Media

Complication: Mastoiditis

  • Describe
  • Action plan?
A
  • Infection of mastoid air cells (direct extension from middle ear)

Presentation

  1. Redness, tenderness, swelling, and fluctuation over the mastoid process
  2. Displacement of the pinna

Treatment

  1. IV Ceftriaxone and/or
  2. Mastoidectomy
25
Q

Acute Otitis Media

Complication: Bullous Myringitis

  • Describe
  • Action plan?
A
  • Painful blister/bulla formation on the TM

Presentation

  1. Painful blister/bulla formation on the TM

Treatment

  1. ABX
26
Q

Acute Otitis Media

Complication: Recurrent Infection

  • Describe
  • Action plan?
A
  • Return of infection within 15 days of completion of tx

Presentation

  1. Return of infection within 15 days of completion of tx

Treatment

  1. Ceftriaxone or
  2. levaquine
27
Q

Acute Otitis Media

Complication: Chronic Otitis Media (more likely in adults due to ETD or anatomical issues)

  • Describe
  • Action plan?
A

Presentation

  1. Long standing, persistently training TM perforation
  2. Otalgia
  3. Aural fullness
  4. Decreased hearing
  5. Otorrhea (foul smelling, persistant)
  6. Flare up after URI or exposure to water

Physical Presentation

  1. TM perforation
  2. Polyp-formation
  3. Cholesteatoma

Treatment

  1. Long term aura ABX
  2. If flare up: may switch to oral
  3. Ensure EENT confirms
28
Q

Case 1

A

Answer is 5

29
Q

Case 2

A

Answer is 4

30
Q

Case 3

A

Answer is 4

31
Q

Case 4

A

Answer is 5

32
Q

Sequelae of TM perforation

A
  1. CHL
  2. Recurrent infection
33
Q

Surgical management of perforations

A
  1. Paper patch
  2. Fat graft
  3. Cartilage patch
  4. Skin graft
  5. Fascia or Perichondrium patch
34
Q

Types of otitis media

A
  1. Acute Otitis Media (suppurative)
  2. Otitis Media Effusion (subacute)
  3. Chronic Serous Otitis Media
  4. Chrons Suppurative Otitis Media
  5. Chronic Non-suppurative Otitis media
35
Q

reduction in the volume of the middle ear because of eustachian tube obstruction followed by absorption of the oxygen in the middle ear and subsequent retraction of the tympanic membrane medially.

A

atelectasis

36
Q

Otosclerosis Treatment

A
  1. Fluoride
  2. Hearing aid
  3. stapedotomy
37
Q

2 theories regarding Cholesteatoma

A
  1. Retraction theory
  2. Mucosal blanket theory
38
Q

Sequelae of Cholesteatoma

A
  1. Hearing loss
  2. Recurrent infection
  3. LSCC dehiscence
  4. tegmen erosion
  5. meningitis
  6. facial nerve palsy
39
Q

Identify:

  • Recurrent infections
  • Aural Polyps
A

Occult cholesteatoma

2017 EENT Clin Med Group (13 decks)

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