PEDS: Common Pediatric Ear Conditions - Hoffman Flashcards
describe Otitis Media with Effusion (OME)
- presence of effusion in an asymptomatic patient
- TM’s appear
- non-bulging
- translucent or opaque
- bubbles or air/fluid levels apparent
- Tympanoscopy - compliance decrased pressure can be positive or negative
describe Bullous Myringitis
- “blisters” on the ear drum
- caused by: Strep. pneumo or Mycoplasma
- if pt has chronic nagging cough - more suspicious of mycoplasma
- antibiotics: Erythromycin or Azithromycin
Describe what you see through your otoscope:
Retraction
Identify this condition and describe the management:
pt presents with severe ear pain that is made worse with chewing and pressure on the tragus
no sxs of fever or URI
otoscopy shows erythematous external auditory canal with moist, white exudate in the canal (see image)
Otitis Externa “Swimmer’s Ear”
- inflammation of th external auditory canal
- high humidity, frequent or prolonged immersion in water, local trauma can compromise local defenses - leading to inflammation and infection
Causative Organisms:
- P. aeruginosa
- children with tympanostomy tubes: S. aureus, S. pneumo, M. cat, Proteus, Klebsiella
TX:
- Topical Antibiotic Drops
- Cortisporin otic suspension if TM is intact
- Acetic Acid Preparations - restore pH
- Tympanostomy Tube: Quinolone otic drops
Identify this condition and describe the management:
pt complains of slight hearing loss, has some itching, denies pain and other symptoms
pt has been utilizing q-tips to clean out her ears
Cerumen Impaction
- usually from mechanical attempts to remove ear wax
- pt should be educated to leave the ear wax alone
TX:
- curettage
- suction (if soft)
- lavage/irrigation
- cerumenolytic agents (Debrox, Cerumenex)
How do you distinguish Acute Otitis Media (AOM) from Otitis Media with Effusion (OME)?
AOM
- symptoms of acute infection
- symptoms of TM inflammation
OME
- no signs of acute infection or TM inflammation
Otitis Media has increased frequency in . . .
- Boys
- Native American/Alaskan Natives
- HIV
- Cleft Palate
- Trisomy 21
- January/February
describe Acute Otitis Media (AOM)
- rapid onset of local and or systemic illness: otalagia, fever, irritability, anorexia or vomiting
- TM’s are
- bulging
- opaque
- erythematous
- Tympanometry - compliance decreased, positive pressure
Identify this condition and describe the management:
Three days ago you treated a patient for AOM with amoxicillin. Her fever and pain has persisted, and presents swelling and redness behind her ear. Upon examination you notice the ear lobe pushed superiorly and laterally.
Mastoiditis
- rare but serious complication of OM
- infection of the periosteum of the mastoid bone
- severe cases: bony destruction and resorption of mastoid air cells
DX: diagnosesd by CT scan
TX:
- Myringotomy - culture and sensitivity
- IV abx: Ceftriaxone with nafcillin or clindamycin
- Surgery for I&D and mastoidectomy if:
- failure of abx after 24-48 hrs
- signs of intracranial complications
Complications: meningitis, brain abscess, facial palsy
Describe what you see through your otoscope:
Scarring on the TM
What are the 3 most common infectious organisms that cause Otitis Media?
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Use this card to test your knowledge of surface landmarks on a normal tympanic membrane.
When is watchful waiting for an otitis media contraindicated?
- children under 2 years old
- ear symptoms greater than 48 hours
- fever present
- severe pain (pain not managed by analgesics)
What are the risk factors for Otitis Media in children?
- Bacterial Colonization (S. pneumo, H. flu, M. cat, GAS)
- Reccurent viral URI’s
- Eustachian tube dysfunction
- Smoke Exposure
- Immunocompromised
- Bottle Feeding
- Young Age
- Genetic Susceptibility/parental history
- Sibling at home/share room with a sibling
- Daycare
Otoscope Practice
An annulus fibrosus
Lpi long process of incus - sometimes visible through a healthy translucent drum
Um umbo - the end of the malleus handle and the center of the drum
Lr light reflex - antero-inferioirly
Lp Lateral process of the malleus
At Attic also known as pars flaccida
Hm handle of the malleus
Describe what you see through your otoscope:
Chronic Perforation
Identify this condition and describe the management:
pt is a 3 year old. hx of a cold last week and now says “my ear hurts.” temp: 99 F
mom reports little Tommy has been irritable lately and is not sleeping well
see otoscope exam photo below & tympanometry results
Acute Otitis Media
- Tympanogram results: positive pressure, decreased compliance
TX:
- Watchful Waiting
- Pain Management
- Antibiotics - Acute course
- Myringotomy Tubes
Identify this condition and describe the management:
A mother brings in her four year old son. Mom has noticed that he is tugging on his ear and itching it a lot. Mom suspects he has decreased hearing on one side. PT does not report pain and does not have any other symptoms.
Ear Foregin Body
removal with a bayonette forceps or ear currette under direct visualization
lavage (DON’T lavage vegetable matter)
mineral oil or lidocaine - insect removal
if not easily removed - refer to ENT
complications: laceration, otitis externa, TM perforation
antibiotic drops should be perscribed after removal
**Alkaline batteries can cause liquefying necrosis**
Treatment Options for Otitis Media
watchful waiting
- first option
- educate parents, give the child 48 hours if no improvement or fever develops call back
- unless
- child under age 2
- ear symptoms >48 hours
- fever present
- severe pain not managed by analgesics
pain management
- acetaminophen or ibuprofen
- topical anesthetic drops (Auralgan/ AB otic)
- tympanoscentesis
Antibiotics (7-10 days)
- Amoxicillin (day care, recurrent cases, recent antibiotic useage)
- Augmentin (amoxicillin/calvulanate)
- Cephalosporins (cefuroxime, cefpodoxime, cefdinir)
- Prophylactic antiboitic use in recurrent otitis media is rare!
Myringotomy Tubes
What is Recurrent Otitis Media?
3 Otitis Media in **6 months **
or
4 Otitis Media in 1 year
