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IDIS > PULM: Ear Infections > Flashcards

PULM: Ear Infections Flashcards

1
Q

otitis externa

  • effects what part of the ear
  • due to what agents?
A
  • outer ear (ear canal + pinna)
  • agents:
  • psuedomonas
  • staph
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2
Q

otitis media

  • effects what part of the ear?
  • is caused by what etiological agents?
A
  • middle ear
  • agents:
  • s. pneumonia
  • h. influenza
  • m. catarrhalis
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3
Q

mastoiditis

  • effects what part of the ear?
  • is caused by what agents?
A
  • mastoid process
  • agents:
  • s. pneumonia
  • s. pyogenes
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4
Q

list the common etiologicl agents for otitis externa, otitis media, & mastoiditis

A

otitis externa: psueodmonas, staphylococcus

otitis media: s. pneumona, h. influenza, m. catarrhalis

mastoiditis: s. pneumonia, s. pyogenes

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5
Q

what symptoms are shared by otitis exerna, otitis media, and mastoiditis?

A
  • itching, pain, discharge of ear:
    • Pruritis (itching) of the ear
    • Otalgia (ear pain)
    • Otorrhea (discharge from the ear)
  • Feelings of aural fullness
  • Decreased hearing
  • Tinnitus (ringing in the ears)
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6
Q

what are the classifications of external ear infections?

A
  • swimmer’s ear (benign OE)
  • malignant OE
  • acute localized OE (furunculosis)
  • eczematous/eczematoid OE
  • herpes zoster oticus
  • otomyocis
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7
Q

swimmer’s ear

  • what type of ear infection?
  • what etiological agents?
  • risk factors?
  • signs/symptoms/diagnosis?
A
  • type of OE
  • agents:
    • psuedomonas, staph aureus
    • fungal: asperilligus
  • risk factors:
    • water sports
    • extreme weather (high temp/humidity)
    • absence of cerumen (ear-wax)
    • local truma
  • signs/symptons & dx:
    • itching that progresses to –> otalgia (pain)
    • palpable periauricular/cervical lymph nodes
    • ​otorrhea (discharge)
      • if asperilligus –> white fuzzy typed with black spheres
      • if pseudomonas –> purulent, green & yellow
    • tenderness of tragus and pinna - kids will NOT tug at their ears
    • typanic membrane moves WELL with pneumatic otoscope
      • ​puff of air on membrane
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8
Q

label the cause of OE in each picture

A

wood’s lamp is highlighting pseudomonas

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9
Q

malignant OE

  • etiological agents?
  • risk factors
A
  • psuedomonas aeruginosa
  • risks factors:
    • immunocompromised pts –> diabetes, AIDS, in chemotherapy
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10
Q

acute localized OE

  • etiologic agent?
  • presentation?
A
  • staph aureus
  • infection of a hair follicle (i.e, furunculosis)
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11
Q

ezcematous/eczemoid OE

  • etiological agents?
  • presentation?
  • risk factors?
A
  • etiological agents: n/a - these is an allergic/autoimmune reaction
  • presentation: crusting, scaling of outer ear

- risk factors: sensitivites, like

  • atopic dermatitis/neurodermatitis/contact dermatitis (from earrings, hearing aids)
  • sensitivity to topical meds
  • psoriasis
  • SLE
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12
Q

herpes zoster oticus

  • etiological agent?
  • what type of ear infection?
  • presentation?
  • diagnosis
A
  • HSV
    • diagnose with Tzank inclusion
  • type of external ear infection
    • painful rash of blisters in/around one ear
    • can progress to Ramsay Hunt Syndrome, in which:
      • facial muscles become paralyzed
      • it is essentially “Bells Palsy” due to HSV
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13
Q

Ramsay Hunt Syndrome (RSH)

  • what is the cause?
  • presentation?
  • how is it treated/prevented?
A
  • caused by herpes zoster oticus (an external ear infection) that extends to CN VII
  • paralysis of facial muscles
    • “bell’s palsy due to HSV”
  • tx: acylovir
  • prevention: VZV vaccine
  • dx: Tzank bodies
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14
Q

malignant otitis externa

  • definition
  • cause, pathogenesis
  • risk factors
  • physical exam signs
  • complications
A
  • definition: infection of the external ear + TEMPORAL BONE*
  • agent - psueodmonas
  • risk factors - I/C (DM = m/c)
  • signs/symptoms
    • temporal headaches
    • ear pain pain out of proportion to PE findings & unrelenting
  • complications:
    • TMJ +/- trismus:
      • trismus = restriction opening mouth/jaw d/t TMJ
    • Bell’s Palsy -unilateral facial paralysis
    • sigmoid sinus thrombosis
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15
Q

dx of malignant OE

A
  • high ESR/CRP
  • positive Tc99M + physical exam findings
  • pathognomonic: granulation tissue of external ear
    • esp at ear-cartilage junction
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16
Q

swimmers ear vs malignant OE:

  • etiologic agents
  • demographics
  • symptoms/exam findings
  • complications
A
  • agents:
    • swimmers:
      • psuedomonas/staph > asperillgus
    • MOE:
      • psuedmonas
  • demographics:
    • swimmers:
      • immunocompetent/young patient
        • risks are swimming/extreme weather/trauma/low ear wax
    • MOE:
      • immunocompromised –> diabetics
  • symptoms/findings
    • swimmers:*these might be true of malignant OE
      • NO ear tugging (tender tragus/pinna)
      • tympanic membrane MOVES WELL w/ pneumatic otoscope
    • MOE:
      • temporal HA
      • tinnitus
      • pain > PE findings
  • complications
    • MOE:
      • Bell’s Palsy
      • TMJ
17
Q

what are categories of otitis media (OM)?

A
  • acute OM
  • OM with effusion (OME)
  • chronic suppurative OM
  • adhesvie OM
  • recurrent OM
18
Q

discuss the pathognesis of acute OM, and the characteristics of the agents involves

A
  • first: a viral infection “preps” middle ear for conolization
  • next: bacteria invade:
    • S. pneumonia –> gram + “lancet shaped” diplococcus
    • H. influenza –> gram - coccobaccilus
    • M. catatarrhalis –> gram - cocci
19
Q

how does acute OM pathophysiology effect the structure of the middle ear?

A
  • viral infection changes the epithelial lining
  • this changes the thickness of the middle ear lining –> pressure –> serous fluid accumulation –> tympanic membrane stiff, wont budge
20
Q

why are children more susceptible to OM than adults?

A
  1. because they have _shorter/horizantal eustachian tube_s - more likely to become obstructed
  2. those < 2 cannot generate Abs against polysaccharides that protect bacterial etiologies against phagocytosis
21
Q

to what patients should give antibiotics for acute OM?

A
  • pts < 6 mos old
  • pts from 6 mos - 2 yrs w/ bilateral AOM
  • pts all age w/
    • severe otalgia
    • otalgia > 48 hrs
    • fever > 102 F
    • TM perforation
    • immunocompromised

hold for ay other pts, then give Ab if no improvement

22
Q

what antibodies to give for AOM (if indicated)?

A
  • amoxicillin
  • amoxicillin/clavunate if they’ve been on Ab within past 30 days
23
Q

treatment for acute OM that is reccurent/becomes chronic?

A

tympanostomy tube insertion

24
Q

acute otitis media

  • etiologic agents
  • clinical presentation
  • tx
A

acute otitis media

  • agents: s pneumo, h flu, m cat
  • clinical presentation: absrupt onset otorrhea w/ yellow discharge, +
    • ear tugging
    • decreased mobility with pneumatoscope
  • tx: Ab sometimes
25
Q

OM with effusion

  • etiologic agents
  • symptoms/exam findings
  • sequelae
A
  • agents - same as AOM
  • symptoms/signs: asx + clear middle ear fluid
    • clear fluid in middle ear - no opacity
    • NO pain
    • NO flu like symptoms (no systemic signs)*
  • sequelae:
    • hearing loss, impaired language skills
26
Q

when to give Ab for OM with Effusion?

A

never. antibiotics dont work.

instead, consider tympanosotmy for OME bilateral or > 3 mos

27
Q

chronic suppurative otitis media

  • etiologic agents
  • symptoms/exam findings
  • sequelae
A
  • psuedomonas, s. aurues, klebsiella, c. diptheria
  • signs/exam findings:
    • persistant purulent discharge + tympanic membrane perforation
      • usually hearing loss
  • sequelae:
    • cholesteatoma
28
Q

adhesive otitis media

  • definition
  • agents
  • symptoms/exam signs
  • complications
  • treatment?
A
  • severe retraction of tympanic membrane
    • TM becomes plastered to middle ear structures
  • complications
    • retraction pocket
    • cholesteatoma
  • treatment: grommet/tube insertion –> normalizes ear pressure
29
Q

what is considered recurrent otitis media?

A
  • 3 acute OM episodes within 6 months
  • 4 + acute OM episodes within 12 months
30
Q

what vaccines protect against otitis media?

A
  • s. pnuemonia
    • PCV13
    • PPSV23
  • H. influenza –> Hib
  • general –> influenza vaccine
31
Q

list each type of OM how it is treated

A
  • acute OM
    • Ab when indicated
      • ​ amoxicillin / amoxicillin/clavunate (if pt already on Ab for 3 months)
    • Gallbreath technique (lymphatic OMM)
    • tympanocentesis - in young infants, immunocompromised, unresponsive to Ab
  • OM + effusion:
    • if > 3 mos: tympanostomy
  • chronic OM:
    • Ab when indicated
  • adhesive OM:
    • tube/grommet insertion
32
Q

what two types of OM can cause choleastomas?

A
  • chronic suppurative
  • adhesive
33
Q

mastoiditis

  • etiologic agents
  • symptoms/exam signs
  • complications
A
  • infection of mastoid process that causes –> coalescence of mastoid air cells
  • etiologic agents:
    • acute: S. pneumonia, H. influenza, S. pyogenes
    • chronic: pseudomonas, S. aureus
  • symptoms/signs:
    • pinna displaced laterally/inferiorly
    • mastoid process redness/swelling/tenderness
    • immobile tympanic membrane (like OM)
    • in babies - refuse to feed
  • complications:
    • deep neck/brain abcesses
    • like malignant OE
      • septic thrombosis of sinus
      • CN VII involvement

IDIS (12 decks)

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