Pediatric ear and hearing d/o Flashcards

1
Q

Most common microbes causing otitis externa

A

Pseudomonas aeruginosa and Staphylococcus aureus

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2
Q

Otomycosis

A

Aspergillus or Candida

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3
Q

OE in neonates

A

GBS

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4
Q

OE antibiotics (not ototoxic)

A

Ciprofloxacin + Dexamethasone = Ciprodex

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5
Q

OE antibiotics (ototoxic)

A

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

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6
Q

OE antibiotics (not ototoxic)

A

Floxin otic (Ofloxacin + Acetic and boric acid)

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7
Q

OE antibiotics (ototoxic)

A

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

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8
Q

OE antibiotics (not ototoxic)

A

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

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9
Q

EAC cleansing agent

A

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

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10
Q

AAP requires what 3 things to diagnose AOM

A
  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
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11
Q

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

A
  1. proximity to adenoids
  2. horizontal orientation of the ET
  3. Narrow tube diameter
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12
Q

ETD causes

A

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

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13
Q

Most common organisms for AOM

A

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

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14
Q

S. pneumonia

A

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

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15
Q

H. influenza

A

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

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16
Q

S. pyogenes

A

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

17
Q

Risk factors + symptoms for AOM

A

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

18
Q

AOM physical exam

A

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)

19
Q

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

A

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

20
Q

Recurrent AOM

A

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

Refer to otolaryngologist

21
Q

AOM complications

A

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

22
Q

OE complications

A

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

23
Q

OE prevention/teaching

A

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

24
Q

AOM prevention/teaching

A

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

25
Otitis media with effusion
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
26
Perforated TM
If d/t AOM, treat with otic atbx, analgesics, and oral atbx No swimming, no water in ears for any reason Usually heal spontaneously
27
Auricular Hematoma
Refer within 7 days of trauma to prevent cauliflower ear (asymmetric cartilage growth/formation) or granulation tissue
28
Cholesteatoma
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.
29
Tympanostomy/Pressue-Equalizing Tubes
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
30
Mastoiditis
History/physical exam: recurrent AOM, fever/otalgia, postauricular swelling Immediate ENT referral for surgery
31
Hearing screening
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