otitis + perf ear drums

Question 1

what causes acute otitis media

Answer 1

ostiomeatal complex dysfunction
bacterial infection (strep pneumo, h.flu, m.cat)
viral
allergy

Question 2

how do you diagnose acute otitis media

Answer 2

moderate-severe bulging of the TM or otorrhea

mild bulging TM + recent ear pain or intense redness

Question 3

when looking in an ear with AOM what do you see

Answer 3

red TM
donut (effusion)
can’t see cone of light

Question 4

when do you treat AOM with abx

Answer 4

patient is >/=6mo w moderate/severe sx or temp >/102.2

nonsevere in 6-23mo if bilateral + you don’t have good f/u

if = 24mo + bilateral

Question 5

common abx for otitis media

Answer 5

amox
augmentin
1st-3rd gen CPN
tmp/smx >2mo
IM ceftriaxone
azithromycin

Question 6

uncommon abx for otitis media

Answer 6

vanco, clinda

Question 7

duration of tx for otitis media

Answer 7

10days

Question 8

pain relief for otitis media

Answer 8

ibuprogen
acetaminophen
antipyrine/benzocaine (auralgan)

Question 9

when should you see improvement of otitis media after treatment

Answer 9

24-48hrs

re-evaluate in 2wks

Question 10

in which situations should you place a tube for otitis media

Answer 10

recurrent AOM
persistent AOM
bilateral OME for 3mo
Recurrent AOM w unilateral or bilateral middle ear effusion at time of assessment for tube candidacy

Question 11

what qualifies as recurrent AOM

Answer 11

3+ well-documented + separate AOM episodes in past 6 mo

OR

4+ well-documented + separate AOM episodes in past 12mo w at least 1 in last 6mo

Question 12

what qualifies as persistent AOM

Answer 12

persistence of sx during abx therapy (treatment failure)

OR

relapse of AOM w.i 1mo of completing tx

Question 13

what causes otitis media w effusion

Answer 13

ostiomeatal complex/eustachian tube dysfunction
sequellae of AOM
viral
unknown
bacterial antigens
biofilm

Question 14

sx of otitis media w effusion

Answer 14

MEE w.o signs or sx of acute ear infection

Question 15

tx of otitis media w effusion

Answer 15

tubes
adenoidectomy
tympanocentesis
myringotomy
oral steroids
watchful waiting

Question 16

cause of perforated TM

Answer 16

infection

trauma- blows to ear, atmospheric, water pressure, ear cleaning

Question 17

tx of perforated TM

Answer 17

avoid eardrops containing gentamicin, neomycin sulfate or tobramycin
systemic abx if otorrhea from TMP
in-office treatments (paper patch, gelfoam, fibrin glue)
surgical (tympanoplasty)

Question 18

auricular hemotoma cause

Answer 18

direct trauma

shearing forces cause separation of anterior auricular perichondrium from cartilage -> hematoma formation

Question 19

who often gets auricular hematomas

Answer 19

boxers
rugby
MMA
wrestling

Question 20

what is the nickname for auricular hematoma

Answer 20

cauliflower ear

Question 21

tx of auricular hematoma

Answer 21

early identification**
drain (needle, I+D)
splints
compression

Question 22

cause of otitis externa

Answer 22

P.aeruginosaa

S.aureus

Question 23

predispositions for otitis externa

Answer 23

anatomic abnormalities
canal obstruction
foreign body
cerumen removal
ear plugs
hearing aids
instrumentation
swimming
derm conditions (eczema, psoriasis, seborrhea)
water in ear
sticking stuff in ears

Question 24

sx of otitis externa

Answer 24

PAIN
canal obstruction or edema
debris
no fever

Question 25

tx of otitis externa

Answer 25

topical abx- ophthalmic preps may be better tolerated than otic
aminoglycosides
polymyxin B
quinolones + acetic acid
consider using w steroids

analgesia
debridement
wicks