Otolaryngology Flashcards
Diagnosis of Acute Otitis Media
Three required elements to make the diagnosis
– Acute onset of symptoms of otalgia
– Presence of a middle ear effusion
– Acute signs of middle ear inflammation
Otitis Media With Effusion (OME)
• Signs of middle ear fluid
– Impaired TM mobility
– Air fluid levels
– Bubbles
– Amber or blue color
• Absence of signs of acute inflammation
Acute otitis media versus Otitis Media With Effusion (OME)
AOM
• Bulging TM • Pus, otorrhea, or bullae • TM amber or blue
OME
• TM red or yellow • Retracted or neutral TM • Air fluid levels or bubbles
Antibiotics for Acute otitis media
Amoxicillin 80-90 mg/kg per day
- Amoxicillin-clavulanate for those: – Treated with ATBs in last 30 days – With concurrent conjunctivitis (H. influenzae ) – Taking prophylactic amoxicillin for recurrent AOM
- Duration of treatment • 10-day course of antibiotics – Children >6 years old may be treated for 5-7 days
What should you use in a patient with acute otitis media with a penicillin allergy with urticaria or anaphylaxis (Type 1) ?
• Penicillin allergy with urticaria or anaphylaxis (Type 1) – Macrolides • Erythromycin + sulfisoxazole • Azithromycin (30 mg/kg single dose) • Clarithromycin – Clindamycin
What should you use in a patient with acute otitis media with a Penicillin allergy – No urticaria or anaphylaxis (Non-type 1)
• Cephalosporins
– Cefdinir (Omnicef) 14 mg/kg per day
– Cefuroxime (Ceftin) 30 mg/kg per day
– Ceftriaxone 50 mg/kg IM/IV
Treatment of Otitis Media With Effusion
- Watchful waiting for three months
- Monitor for hearing loss at three months
- Tympanostomy tubes is preferred procedure
- Do not use antibiotics, antihistamines, or decongestants
- 2011 Cochrane Review suggests oral or nasal steroids with or without antibiotics hastens resolution of OME.
Rhinosinusitis Classification
– Acute – < 4 weeks
– Sub-acute – 4-12 weeks
– Chronic – > 12 weeks
– Recurrent – 4 or more episodes per year without symptoms between episodes
Acute Rhinosinusitis symptoms and etiology
Symptoms
– Purulent nasal drainage
– Nasal obstruction
– Facial pain, pressure or fullness
Etiology
– Viral is most common etiology
– Bacterial rhinosinusitis – 0.5-2%
Indicators of Bacterial Rhinosinusitis
- Duration of seven or more days
- Worsening of symptoms
- Moderate to severe pain and fever >101 o F
- Bimodal illness – worsening of symptoms after initial improvement
Treatment of Viral Rhinosinusitis
- Self-limited disease – treatment does not shorten the course
- Analgesics (NSAIDs, acetaminophen)
- Saline nasal sprays (irrigation)
- Topical nasal steroids
- Topical decongestants
- Topical ipratropium (Atrovent)
- Mucolytics (guaifenesin)
- Anti-histamines may over dry and increase discomfort • Zinc preparations show no benefit
Antibiotics for Bacterial Rhinosinusitis
• Amoxicillin-clavulanate now recommended as empiric choice
– High dose (2 g BID or 90 mg/kg/day)
if: • >10% penicillin resistant S. pneumonia
- Severe infections
- Immunocompromised
- Daycare attendance
- <2 y/o or >65
Chronic Rhinosinusitis
- Saline nasal sprays/irrigations
- Intranasal steroids – sprays and instillations
- Oral steroids
- Topical and oral antimicrobials
- Leukotriene antagonists
- Referral to ENT specialist
Peripheral Causes of Vertigo
Peripheral Vertigo
• Benign paroxysmal positional vertigo
– Canalithiasis – Brief spinning spells (seconds) when head moved – Nausea, but rarely vomiting – No hearing loss, ear pain or tinnitus
• Vestibular Neuronitis
– Viral or post-viral inflammation of labyrinth – With unilateral hearing loss, it is called “labyrinthitis” – Last 1-2 days before resolution
• Herpes Zoster Oticus (Ramsay-Hunt Syndrome)
• Menier’s Disease
– Endolymphatic Hydrops – Associated with tinnitus, hearing loss and ear fullness
• Acoustic neuroma
– Vertigo is minor, tinnitus and hearing loss are main complaints
Central Vertigo
• Migrainous vertigo
• Wallenberg’s syndrome (CVA)
• Cerebellar hemorrhage or infarction – Sudden intense vertigo and vomiting – Markedly impaired gait – falls to the side of the lesion
