Module 3 - Ear Pain

Question 1

Weber + Rinne Tests *

Answer 1

Expected Findings
Conductive Hearing Loss
Sensorineural Hearing Loss
** Look at chart in notes

Question 2

Acute Otitis Media (AOM) Primary + Secondary Prevention

Answer 2

• breast feeding > 3mo
• Discourage pacifier use after 6mo
• Minimize smoke exposure
• Pneumonia Conjugate Vaccine (PCV7) and influenza vaccine

Secondary Prevention
- none

Question 3

Pathogens of AOM *

Answer 3

• Viral
• Bacterial:
  > STREP PNEUMONIAE: Pneum vaccines are primary
  prevention (less likely to resolve without treatment,
  more sicker looking ie fever)
  > Haemophilus Influenza
  > Moraxella Catarrhalis

Question 4

Antibiotic Treatment AOM*

Answer 4

1st line: amoxicillin then augmentin
2nd line: cefs (cephalosporin)
PCN allergy: clindamycin

Question 5

OME

Answer 5

retraction
gray dull
not completely translucent
snapping or clicking or fullness
no abx
6w to 3m to heal

Question 6

Comparison of OME vs AOM *

Answer 6

Look at Chart in Notes

Question 7

History and PE together to differentiate OME and AOM *

Answer 7

• Recent cold symptoms
• Ear Pain
• TM bulging
• Opaque (w/erythema)
• Immobile TM

Question 8

Acute Otitis Externa (AOE)

Answer 8

• (swimmers ear?)
• Erythema + edema of external auditory canal
• Due to infected hair follicles
• No systemic symptoms

Question 9

AOE Pathogens *

Answer 9

AOE can progress to a life threatening infection with risk of meningitis and severe neurological impairment (but no systemic symptoms)

All gram (-) and found in bodies of water
- Pseudomonas aeruginosa
- Bacteroides Fragilis
- Proteus species
All gram (+)
- Staph Aureus

• Cultures not usually done so it’s important to have gram -/+ coverage.
• FLUOROQUINOLONES TREAT BOTH

Question 10

AOE Treatment *

Answer 10

• Ciprofloxacin 0.3% or Dexamethasone 0.1%: 4gtts BID x 7 days
  OR
• Ofloxacin: 10gtts daily x 7 days
  (treats gram - and gram +) (these can be used with perforated TM and usually with external you cant see which is why you use these)
• Can also clean so abx can penetrate with hydrogen peroxide or saline but usually to sensitive/painful - only if TM is intact!!! if you cant see it then don’t clean it*

Question 11

Cerumen Impaction S/S *

Answer 11

• Hearing loss
• Tinnitus
• Fullness
• Itching
• Otalgia
• Discharge
• Odor
• Cough
• Diminished cognitive function in elderly + cognitive impaired

Question 12

Primary Prevention of Cerumen Impaction *

Answer 12

DO NOT
- Overclean the ears
- Put anything smaller than an elbow in the ear
- Ear candle
- Ignore symptoms
- Irrigate/Try cerumen removing/softening gtts if pt has hx of ear surgery or performation

Secondary Prevention
- Screening

Question 13

Patient Education on Cerumen Impaction *

Answer 13

Listen to slide
- not advised: daily olive oil gtt or sprays, ear candling, probes or foreign body

Question 14

Primary vs Secondary Otalgia

Answer 14

review types and differences in pain AFP article

Primary: pain that originates from ear (more common in children)
-continuous and progressive
- cholesteatoma: pearl mass through TM, asymptomatic early but then hearing loss and otorrhea (drainage)

Secondary: pain that originators outside of ear (more common in adults)
- intermittent
- bells palsy
- head neck tumor
- neuralgias
- salivary gland disorder
- TMJ syndrome
- temporal arteritis