Pediatric ear and hearing d/o

Question 1

Most common microbes causing otitis externa

Answer 1

Pseudomonas aeruginosa and Staphylococcus aureus

Question 2

Otomycosis

Answer 2

Aspergillus or Candida

Question 3

OE in neonates

Answer 3

GBS

Question 4

OE antibiotics (not ototoxic)

Answer 4

Ciprofloxacin + Dexamethasone = Ciprodex

Question 5

OE antibiotics (ototoxic)

Answer 5

Corisporin otic suspension (Polymyxin B and neomycin + hydrocortisone + hydrocloric acid)

Question 6

OE antibiotics (not ototoxic)

Answer 6

Floxin otic (Ofloxacin + Acetic and boric acid)

Question 7

OE antibiotics (ototoxic)

Answer 7

Cipro HC otic (ciprofloxacin + hydrocortisone + clacial acetic acid) Do not use with TM perf.

Question 8

OE antibiotics (not ototoxic)

Answer 8

Vasocidin opthamic (Sulfacetamide sodium + prednisone) Excellent broad spec coverage

Question 9

EAC cleansing agent

Answer 9

Domeboro otic (Acetic acid) No not use if TM integrity unknown

Question 10

AAP requires what 3 things to diagnose AOM

Answer 10

1. Recent, abrupt onset of middle ear inflammation and effusion (pain, irritability, otorrhea, and/or fever)
2. MEE confirmed by bulging TM, limited mobility by pneumoatic otoscopy, and/or otorrhea
3. TM erythema or ear pain

Question 11

Eustachian tube dysfunction (ETD) is more common in children due to:

Answer 11

1. proximity to adenoids
2. horizontal orientation of the ET
3. Narrow tube diameter

Question 12

ETD causes

Answer 12

URI, craniofacial anomalies, allergies, adenoid hypertrophy, tobacco smoke exposure

Question 13

Most common organisms for AOM

Answer 13

**S. penumoniae**, Haemophilus influenzae, Moraxella catarrhalis, and S. pyongenes (GBA)

Question 14

S. pneumonia

Answer 14

Almost always the cause of bullous myringitis (small, fluid-filled blisters form on the eardrum), most common cause AOM

Question 15

H. influenza

Answer 15

Common cause of AOM, most common for unilateral OM, severe TM inflammation, and otitis-conjunctivitis syndrome

Question 16

S. pyogenes

Answer 16

Most common for AOM in older children, responsible for more TM ruptures, more likely to cause mastoiditis

Question 17

Risk factors + symptoms for AOM

Answer 17

Prematurity, craniofacial anomalies, daycare attendance, disrupted sleep, lethargy, dizziness, tinnitus, unsteady gait, diarrhea and vomiting, sudden hearing loss, stuffy nose, rhinorrhea, sneezing

Question 18

AOM physical exam

Answer 18

Middle ear effusion AEB: bulging TM, decreased TM translucency, dec TM mobility, air-filled level behind TM, otorrhea; also inc vascularity with obscured landmarks, red/yellow/purple TM, bullae filled with straw-colored fluid (bullous myringitis); TM color: amber (OME) white/yellow (AOM or OME)

Question 19

AOM treatment if no AOM in last 30 days, no conjunctivitis, no allergies

Answer 19

1st: Amoxicillin
2nd: Augmentin or 3rd gen cephalosporin if AOM in last 30 days, PCN allergy, or conjuncitivits concurrently
3rd: Ceftriaxone for vomiting child or intolerant of oral meds

Question 20

Recurrent AOM

Answer 20

>3 distinct and well-documented bouts of AOM in 6mo or >4 in 12 mo.

Refer to otolaryngologist

Question 21

AOM complications

Answer 21

Persistent AOM, persistent OME, TM perforation, OE, matoiditis, cholesteatoma, tympanosclerosis, hearing loss, ossicle necrosis, pseudotumor cerebri, cerebral thrombophlebitis, facial paralysis

Question 22

OE complications

Answer 22

Surrounding tissue infection, irriatated furnculosis, malignant OE with necrosis by pseudonomonas

Question 23

OE prevention/teaching

Answer 23

No water in ear canals, dry ear canals with blow dryer, [2 p. rubbing alcohol/1 p. white vinegar/1 p. distilled water] 3-5 drops per day, avoid cleaning/scratching

Question 24

AOM prevention/teaching

Answer 24

Breastfeed, no bottle propping, feed infants more upright, no smoke exposure, pneumococcal vaccine, flu vaccine, xylitol liquid or chewing gum 3-5x/day, less children in daycare class, avoid antibiotics if possible

Question 25

Otitis media with effusion

Answer 25

Middle ear effusion w/o s/sx of infection

Causes: recent AOM, ETD, viral illness, allergies, anatomic abnormalities, barotrauma

Reevaluate every 3 months until resolved. If >6mo, refer out

Question 26

Perforated TM

Answer 26

If d/t AOM, treat with otic atbx, analgesics, and oral atbx

No swimming, no water in ears for any reason

Usually heal spontaneously

Question 27

Auricular Hematoma

Answer 27

Refer within 7 days of trauma to prevent cauliflower ear (asymmetric cartilage growth/formation) or granulation tissue

Question 28

Cholesteatoma

Answer 28

Epidermal inclusion cyst of the middle ear or mastoid of desquamated debris from keratinizing (cyst full of old skin)

Result of chronic ear infection

Surgery usually involves a mastoidectomy to remove the disease from the bone, and tympanoplasty to repair the eardrum.

Question 29

Tympanostomy/Pressue-Equalizing Tubes

Answer 29

Refer if: bilateral OME > 3 mo, unilateral OME > 6 mo, or cumulative OME > 6 of 12 mo

CHL with MEE

Recurrent AOM

Prevention of acquired cholesteatoma

Question 30

Mastoiditis

Answer 30

History/physical exam: recurrent AOM, fever/otalgia, postauricular swelling

Immediate ENT referral for surgery

Question 31

Hearing screening

Answer 31

Evoked otoacoustic emmission (EOAE)/Auditory brainstem response (ABR) for newborn screens

Audiometry decibels at various frequencies for older children

Conditioned play audiometry (CPA) 2.5yrs+ simple task when sound plays

Pneumatic otoscopy assess TM mobility

Tympanometry eval. middle ear fx by movement of TM, creates graph called tympanogram. Type A is normal, B has no peak or a flattened wave=effusion, perforation, or PETubes