Otic Treatments

Question 1

Acute Otitis Media

Answer 1

inflammation of the middle
most prevalent disorder of childhood
rapid onset, middle ear effusion, inflammation
May be bacterial, viral or both
80% resolve spontaneously in a week

Question 2

AOM

Answer 2

All children whould receive paine medication (acetominophen, ibuprofen, etc)

Question 3

AOM Clinical guidelines

Answer 3

Observe for 48-72 hours, if not resolved then antibacterial therapy is implemented.

Question 4

Whether to treat or not?

Answer 4

Patient age
illness severity
degree of diagnostic certainty

Question 5

Treatment of AOM

Answer 5

Amoxicillin high dose
If antbx resistance-use amoxicillin/clavulanate (Augmentin ES-600) Diarrhea is common, so treat with highest concentration, do not double a low dose. EX or SR are preferred Treatment of less than six and sever AOM tx 10 days. Over 6 and without severe 5-7 days

Question 6

Reduce AOM

Answer 6

By getting influenza vaccine and Prevnar 13

Question 7

Patients < 6 months

Answer 7

should all be treated with high dose Amoxicillin. If type 1 hypersensitivity to PCN’s use 2nd or 3rd generation cephlosporins.

Question 8

AOM-should show improvement in 72 hours

Answer 8

If not come back:

could be resistant organism, viral infection, inadequate concentration, nonadherence

Question 9

Antibiotic resistant AOM

Answer 9

Over 72 hrs no resolution, day care attencance, <2 years old, Antbx exspoure 1-3 monthsprior, winter and spring seasons

Question 10

OME

Answer 10

fluid in the middle ear without evidence of local systemic illness. Do not use antibiotics on this.

Question 11

OE

Answer 11

Infection of the outer ear associated with swimming, trauma (q-tips), hearing aids, high and humid temps.

Question 12

OE treatment

Answer 12

Mild or resolving OE can be tx topically with acidifying agent (2% acetic acid), drying agent (alcohol), anti-inflammatory (hydrcortisone)

Question 13

Moderate OE Tx

Answer 13

topical antibiotics-Fluoroquinolone eardrops 90% of cases. Orral antiz rarely needed. If there is cellulitis in the face, neck or sever ear edema, tx with oral antibx.

Question 14

OE First line tx

Answer 14

Fluroquinolones-ciprofloxacin and dexamethasone (Ciprodex-Otic) and ofloxacin (Floxin) These can be given with TM perforation and or P.E.tubes. No oral fluroquinolones in children < 198 due to risk of tendon rupture. They get Dicloxacillin or TMP-SMX for oral

Question 15

The old way of Tx and now second line is combination neomycin, hydrocortisone, polymyxin B.

Answer 15

Increasing resistance, not safe for children with TM perforations or tubes.

Question 16

Otic analgesic can be used if no perforation

Answer 16

Antipyrine/benzocaine, the generic form of Auralgan is an example of tx Auralgan was discontinued in the us in 2008 but the generic is available

Question 17

Cerumen

Answer 17

should be removed with irrigation using a cerumenolytic OTC solution such as cerumenex (triethanolamine polypeptide oleate) not if TM is ruptured.

Question 18

Ear examine

Answer 18

Adults lift up on pinna and back
pull pinna down and back if under 3
use room temp fluid
1:3 acetic acid/alcohol > 3yrs age to dry out ear.

Question 19

Necrotizing OE

Answer 19

Managed through cleansing and use of ofloxacin solution. Mild disease oral cipro

Question 20

Fungi OE is

Answer 20

Aspergillus

Question 21

Fungi OE managed through cleansing and acidifying drops.

Answer 21

A topical Clotrimazole and if unresponsive an oral antifungal such as itraconazole