Pediatric ear and hearing d/o Flashcards
Most common microbes causing otitis externa
Pseudomonas aeruginosa and Staphylococcus aureus
Otomycosis
Aspergillus or Candida
OE in neonates
GBS
OE antibiotics (not ototoxic)
Ciprofloxacin + Dexamethasone = Ciprodex
OE antibiotics (ototoxic)
Corisporin otic suspension (Polymyxin B and neomycin + hydrocortisone + hydrocloric acid)
OE antibiotics (not ototoxic)
Floxin otic (Ofloxacin + Acetic and boric acid)
OE antibiotics (ototoxic)
Cipro HC otic (ciprofloxacin + hydrocortisone + clacial acetic acid) Do not use with TM perf.
OE antibiotics (not ototoxic)
Vasocidin opthamic (Sulfacetamide sodium + prednisone) Excellent broad spec coverage
EAC cleansing agent
Domeboro otic (Acetic acid) No not use if TM integrity unknown
AAP requires what 3 things to diagnose AOM
- Recent, abrupt onset of middle ear inflammation and effusion (pain, irritability, otorrhea, and/or fever)
- MEE confirmed by bulging TM, limited mobility by pneumoatic otoscopy, and/or otorrhea
- TM erythema or ear pain
Eustachian tube dysfunction (ETD) is more common in children due to:
- proximity to adenoids
- horizontal orientation of the ET
- Narrow tube diameter
ETD causes
URI, craniofacial anomalies, allergies, adenoid hypertrophy, tobacco smoke exposure
Most common organisms for AOM
**S. penumoniae**, Haemophilus influenzae, Moraxella catarrhalis, and S. pyongenes (GBA)
S. pneumonia
Almost always the cause of bullous myringitis (small, fluid-filled blisters form on the eardrum), most common cause AOM
H. influenza
Common cause of AOM, most common for unilateral OM, severe TM inflammation, and otitis-conjunctivitis syndrome
S. pyogenes
Most common for AOM in older children, responsible for more TM ruptures, more likely to cause mastoiditis
Risk factors + symptoms for AOM
Prematurity, craniofacial anomalies, daycare attendance, disrupted sleep, lethargy, dizziness, tinnitus, unsteady gait, diarrhea and vomiting, sudden hearing loss, stuffy nose, rhinorrhea, sneezing
AOM physical exam
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)
AOM treatment if no AOM in last 30 days, no conjunctivitis, no allergies
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
Recurrent AOM
>3 distinct and well-documented bouts of AOM in 6mo or >4 in 12 mo.
Refer to otolaryngologist
AOM complications
Persistent AOM, persistent OME, TM perforation, OE, matoiditis, cholesteatoma, tympanosclerosis, hearing loss, ossicle necrosis, pseudotumor cerebri, cerebral thrombophlebitis, facial paralysis
OE complications
Surrounding tissue infection, irriatated furnculosis, malignant OE with necrosis by pseudonomonas
OE prevention/teaching
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
AOM prevention/teaching
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
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
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
Auricular Hematoma
Refer within 7 days of trauma to prevent cauliflower ear (asymmetric cartilage growth/formation) or granulation tissue
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.
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
Mastoiditis
History/physical exam: recurrent AOM, fever/otalgia, postauricular swelling
Immediate ENT referral for surgery
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
