Module 2 ear disorders peds

Question 1

Types of acute otitis media

Answer 1

Acute otitis media (AOM)
bullous myringitis
persistent AOM
Recurrent AOM

Question 2

Acute otitis media

Answer 2

suppurative effusion of the middle ear

Question 3

Bullous myringitis

Answer 3

AOM in which bullae form between the inner and middle layers of the TM and bulge outward

Question 4

Persistent AOM

Answer 4

AOM that has not resolved with antibiotic therapy has been completed or recurs within days of tx

Question 5

Recurrent AOM

Answer 5

3 bouts of AOM within a 6-month period
OR
4 within a 12-month period

Question 6

Risk factors for OM, chronic OM, or OME

Answer 6

genetic/sibling with hx
Native American or Native Alaskan
Caucasian
prematurity
less than 2
unimmunized
day care
sharing a bedroom
breastfeeding for less than 6 months
parental smoking/smoke exposure
pollution exposure
overwt or obese
feeding in supine position
autumn season
male
early onset OM
bilateral OME
lower socioeconomic status
crainofacial anomalies/congenital syndromes

Question 7

AOM s/s

Answer 7

ear pain
irritability and pulling at ear
otorrhea
fever
disrupted sleep/inability to sleep
lethargy
dizzy
tinnitus
unsteady gait
diarrhea and vomiting
sudden hearing loss
stuffy nose
rhinorrhea
sneezing

Question 8

AOM physical exam

Answer 8

Bulging TM
Dec. TM translucency
Absent or dec. TM mobility
Air-fluid level behind TM
otorrhea

Question 9

AOM complications

Answer 9

persistent AOM
persistent OME
TM perforation
Otitis Externa
mastoiditis
cholesteatoma
typanosclerosis
hearing loss for several months
ossicle necrosis
pseudotumor cerebri
cerebral throbmophlebitis
facial paralysis

Question 10

Prevention of AOM

Answer 10

EBF until 6 months
avoid bottle propping, feeding lying down
avoid passive smoke exposure
pneumo vaccine
annual influenza
xylitol liquid or chewing gum
daycare with fewer children

Question 11

otitis medial with effusion

Answer 11

presence of middle ear effusion without s/s of AOM
- dec. mobility of the TM and interferes with sound conduction
Causes:
- inflammatory process after AOM
- viral illness
- anatomic abnormalities
- barotrauma
- allergies

Question 12

Eustachian tube dysfunction changes middle ear mucosa

Answer 12

1. mucosa becomes secretory with inc. mucus production
2. mucus absorbs water as the mucosa becomes viscous
3. fluid becomes stuck behind the TM

Question 13

Biofilms

Answer 13

mixed microorganisms enclosed in a polymeric matrix that adhere to surfaces
- may explain persistent OME

Question 14

OME s/s

Answer 14

afebrile with no s/s
Sometimes:
- intermittent mild ear pain
- fullness in ear
- dizzy
- impaired balance

Question 15

Physical exam of OME

Answer 15

dec. TM mobility
abnormal appearing TM
air-fluid level or bubble may be seen

Question 16

Mastoiditis

Answer 16

suppurative infection of the mastoid cells
- mucoperiosteal lining of the mastoid air cells becomes inflamed -> swelling and obstruction cause by drainage from mastoid
- may occur with or following an AOM

Question 17

mastoiditis clinical findings

Answer 17

concurrent or recurrent AOM
fever
otalgia
persistent OM unresponsive to antibiotics
postauricular swelling

Question 18

postauricular swelling

Answer 18

infants: edema above the ear -> pinna displaced inferiorly or laterally
Older children: edema pushed earlobe superiorly and laterally

Question 19

typanosomy tubes insterted because

Answer 19

persistent middle ear fluid
frequent ear infections
ear infections that persist after antibiotics

Question 20

criteria for tympanostomy

Answer 20

• bilateral OME for 3 or more months
• unilateral OME for 6 or more months
• recurrent episodes of OME with more than 6 in last 12 months
• conductive hearing loss assoc. with MEE
• recurrent AOM
• prevention of acquired cholesteatoma due to a retraction of the TM

Question 21

complications of tympanostomy tubes

Answer 21

otorrhea
otitis externa
granuloma
cholesteatoma
tube obstruction
persistent TM perforation
typanosclerosis