Midterm Flashcards
What is the physical exam you would see for acute otitis media (AOM)
Bulging of the tympanic membrane, impaired mobility, loss of bony landmarks, Erythematous, otorrhea, effusion
+ fever (39C) and Pain
What past medical history would a patient with AOM present?
Cleft lip/palate, immune status, hearing loss, Hx of acute or chronic otitis media, presence of myringotomy/ tympanostomy tubes
What past social history would a patient with AOM present?
Day care, bottle feeding, pacifier use, exposure to tobacco smoke
What are the common risk factors for AOM, COM, OM with Effusion?
Age (<3yrs), FH, Day care, exposure to tobacco smoke, lactation less than 6 months, snoring, URI, Hx: AOM/ recurring, Low SES, pacifier use, allergy/atopy
What bacterial pathogen is most cultured that is responsible for causing AOMs?
S. Peumoniae
What is one protective/ preventative factors for AOM/ COM/ OM with effusion?
Lactation beyond 6months
What are the symptoms for AOM?
Pain, pressure in one or both ears, Pain radiating to outer ear/jaw/head. Hearing loss, vertigo, ear drainage
What are the nonspecific associated patient complaints for AOM?
Fever, irritability, anorexia, N/V, diarrhea, eye drainage (conjunctivitis), upper respiratory symptoms, nasal congestion, sore throat.
When does the patient need ENT referral?
AOM has not cleared after 3 courses of abx
Recurrent AOM
Chronic serous otitis or chronic otitis media
Perforated TM with hearing loss and dizziness
What device would a clinician use to test for mobility of the tympanic membrane?
Pneumatic otoscopy (insufflation)
What warrants a diagnosis of AOM?
Eryhema of TM + Bulging (loss of bony landmarks) + Immobility (using Pneumatic otoscopy),
When would clinician know perforation of the TM has occurred?
subsequent otorrhea
What are the guidelines for treating AOM with antibiotics?
Starting at 6months to greater than 2 years, with severe otorrhea, bilateral or unilateral without severe s/sx
When is follow up necessary for patient with AOM?
When patient is prescribed antibiotics and symptoms persist or worsen post Tx
What is the antibiotics of choice for AOM Tx?
Amoxicilin
When is amoxicillin not appropriate?
If patient is allergic to it, antibiotics received in previous month, concurrent otitis- conjunctivitis syndrome, recurrent AOM or UTIs (prescribing it as prophylaxis), AOM unresolved with amoxicilin.
What is an alternative antibiotics choice for AOM if amoxicillin is not appropriate?
Amoxicillian- clavulanate
When is follow up necessary?
48-72 hours if symptoms not improved.
8-12 weeks (or at well child care appnt) for recheck of eats.
What considerations would you consider when prescribing antibiotics for AOM?
Patient’s age (6months -2+yrs),
severity of S/Sx, otorrhea, laterality.
What is otitis media with effusion (OME)?
presence of fluid in the middle ear without S/Sx of acute ear infection.
What are the S/Sx of OME?
May have mild URI symptoms.
S/Sx of acute ear infection not present.
Often asymptomatic
When does OME usually occur?
After AOM
Or due to chronic inflammation in response
What are the risk factors for OME?
Same as AOM: Exposure to tobacco smoke Low SES Pacifier use Bottle feeding Allergy/atopy Day care
What is the clinical presentation of patients with OME?
Balance can be affected.
Conductive hearing loss.
No acute illness/ usually asymptomatic
What Diagnostics is used to determine OME?
Pneumatic otoscopy (primary method), Tympanometry Myringotomy
What does pneumatic otoscopy used for?
determine TM mobility
When is tympanometry used?
when diagnosis is still uncertain.
what does tympanometry show?
measures the flexibility of the TM
Why is Myringotomy considered the gold standard when diagnosing OME?
Withdraws fluid from middle ear via making an incision in TM to confirm OME
What are the treatment options for OME?
Watchful waiting, rechecking every 3 months
Should clinicians recommend antibiotics, antihistamines, decongestants or steroids (for patient’s without allergies)?
NO
If OME persists over 12 weeks/ 3 months, what should be recommended
Audiogram and speech/ language evaluation
When and why should Audiogram and speech/ language evaluation be performed for patient with OME?
Patient with language delay, learning problems, hearing loss.
when is surgical indicated for patient with OME?
Complications of AOM (mastoiditis) Persistent OME Recurrent AOM Structural changes in TM Individuals with craniofacial anomalies Middle ear ventilation disorders >3months
What does the surgery involve when indicated for OME?
Making an incision into the TM and placing a tube to drain the fluid
What are the two chronic conditions that could occur as complications from OME?
chronic serous otitis media (lasting 3 moths)
chronic suppurative otitis media (not responding to abx)
What are the few complications with OME?
Mastoiditis (inflammation of the mastoid bone)
persistent perforation (perforation of the TM)
Cholesteatoma (noncancerous skin/ sac/ cyst growth)
When does recurrent AOM grant ENT referral?
When 3 or more cases within 6 months or more than 4 infections a year
Recurrent despite: Treated with abx (prophylactic), Decreased risk factors, PNA/Flu immunizations, myringotomy/ tympanostomy tubes
What is otitis externa (OE)?
inflammation of external auditory canal
Is OE usually more bacterial or viral in origin?
Bacterial. S. aureus & Psuedomonas as most common.
What are the risk factors for OE?
trauma to ear canal lack of cerumen moisture and warmth in ear canal chronic eczema infection of hair follicle recent ear surgery or instrumentation
What are the symptoms of OE?
ear pain, pruritis of ear canal or external ear, discharge from canal, conductive hearing loss, tinnitus, dizziness, chronic cough if impacted cerumen
What are some of the physical exam findings of the external ear for patient with OE?
pain with manipulation of pinna or tragus. erythema, crusting, edema of the external ear
What are some of the physical exam findings of the ear canal for patient with OE?
erythema, edema, occluded canal, yellow, brown, whitish/ grayish discharge, profuse/ prulent discharge
What are some of the physical exam findings of the TM for patient with OE?
No middle ear fluid, mobile structures
What are some of the physical exam findings of the lymph nodes for patient with OE?
preauricular/ cervical node tenderness with more severe infection
What is the treatment for OE?
Topical abx, topical corticosteroids, acidifying agents, analgesics
What should be included in the patient education?
Proper use of ear drops, avoiding water in ear until symptoms improve, preventing OE
When is ENT referral necessary?
Canal obstruction, malignant OE
When should symptoms of OE resolve?
within 36-48 hours
What are the 3 most common viral etiology for adult pharyngitis?
adenovirus, parainfluenza, rhinovirus
What are the most common bacterial etiology for adult pharyngitis?
Group A beta-hemolytic streptococcus
H.influenzae
Mycoplasma pneumoniae
Neisseia gonorrhoeae
What are precipitating factors for pharyngitis?
exposure to infection, allergies, pollutants, trauma to oral cavity, excessive use of voice, unprotected oral sex
What are the symptoms of pharyngitis?
URI symptoms, allergy symptoms, fever, headache, abdominal pain, lesions in mouth, drooling, hoarseness, malaise, myalgias.
What complications may result for people with group A beta-hemolytic strep pharyngitis?
rheumatic fever, post strep glomerulonephritis
what to look for on a PE?
fever, altered breathing, pallor, flushed skin,
