Test 2 Flashcards
Otitis Media cause
Susceptible patient multiple risk factors => get allergy or URI → Blocked Eustachian tube
Otitis Media population affected
children under 10
Otitis Media symptoms
Pain
Ear drainage (otorrhea)
Fever
Lethargy
Irritability
Anorexia
Vomiting
Unilateral
Sensation of blockage
Hearing loss
Worse pain in evening
Eye symptoms
Otitis Media RF
Fall
1-5 years
Dairy at early age
Supine bottle feeding with sniffles causes aspiration into eustachian tube
Second or third hand smoke
Vitamin A def
Vitamin D def
Zinc def
Eskimo and Native american
Allergy, atopy, and food sensitivities
Fetal alcohol syndrome, Down’s syndrome, cleft palate
High hard palate
Sibling with URI
Daycare
Breastfeeding < 6 months
Early introduction of solid foods and reliance on formula
Gastroesophageal reflux disease (GERD)
Pacifier use
Antibiotic treatment in early life
Male children
Genetics
Previous viral infection
Housing
Otic Barotrauma cause
air travel or scuba diving
Otic Barotrauma sx
pain can be severe with ear fullness, < yawning, hearing loss, and dizziness.
Otic Barotrauma complication
TM perforation or round window membrane rupture
Impacted cerumen sx
Vague discomfort to severe pain; impaired hearing, dizziness, ear fullness, reflex cough, tinnitus, itchiness,
Impacted cerumen cause
history of “Q-tip abuse”
increased cerumen production
Impacted cerumen treatment
cerumenolytic agents
irrigation
manual removal
elephant ear syringe
ear drops to soften wax- olive or calendula oil or OTC preparation of Carbamide peroxide 6.5 % ® Debrox or Murine
Impacted cerumen Contraindication to treating
non-intact tympanic membrane
AOM
otorrhea
ear canal stenosis, exostoses, diabetes mellitus, immunocompromised state, or anticoagulant therapy
Impacted cerumen complications
tympanic membrane perforation, ear canal laceration, infection of the ear otitis externa and malignant otitis externa
foreign bodies cause
Sticking things in ear
Food
Beads
Plastic toys
Pebbles
Popcorn kernels
Insects
osteoma of the canal cause
history of cold-water exposure, chronic periostitis
referred pain causes
TMJ dysfunction, molars, cervical spine, head and neck malignancies, TMD
otitis media with efffusion (serous) cause
allergies or URIs
Herpes zoster oticus sx
Otalgia
Facial palsy
Pathognomonic vesicular rash of the pinna
Hearing loss
Vertigo
foreign bodies treatment
Water irrigation
Forceps removal
Roman loops
Right angle ball hooks
Suction catheters
alcohol, 2% lidocaine, or mineral oil- insects
Acetone for styrofoam
EENT referral
osteoma of the canal sx and complication
asymptomatic or conductive hearing loss
Complication: otitis externa
osteoma tx
surgery
hekla lava
What are red flags PMH/SH/age for further workup of ear pain?
smokers, drink alcohol, are older than 50 years, or have diabetes
Serous Otitis Media or OME sx
Painless
Popping or gurgling sound
Plugged feeling
Aural fullness
Serous Otitis Media or OME PE
TM yellow, amber; not pearly gray
Tympanogram is flat-Type B
Insufflation shows little or no movement
Conductive hearing loss: Abnormal whispered voice test. (Weber tuning fork test may lateralize to the bad ear, Rinne’ BC > AC)
Tympanometry
measurment of reflected pressure on the TM
What dose type A indicated on tympanometry
normal
What dose type B indicated on tympanometry?
Fluid, early AOM, OME
What dose type c of tympanometry mean?
Eustachian Tube dysfunction
eosinophils otitis media presentation and population effected
highly viscous yellow effusion containing eosinophils
bronchial asthma
infectious myringits cause
viral, bacterial, strep pneumonia
Infectious myringitis sx
Red painful ear
Vesicles on Tympanic membrane
Hearing loss
Infectious myringitis complications
Hearing loss
Herpes Zoster Oticus cause
herpes zoster, Reactivation of the varicella-zoster virus (VZV) along the distribution of the sensory nerves innervating the ear, which usually includes the geniculate ganglion,
Herpes Zoster Oticus sx
Otalgia
Facial palsy
Pathognomonic vesicular rash of the pinna
Hearing loss
Vertigo
Mastoiditis cause
complication of untreated or poorly treated AOM
Mastoiditis sx
Pain behind the ear
Fever
Mastoiditis PE
tender, red mastoid; spasm of ipsilateral SCM; bulging in canal, protrusion of auricle
Mastoiditis complication
Abscess into brain
Meningitis
Death
Mastoiditis tx
Antibiotics
otitis externa cause
changes in pH from acid to alkaline, bacterial infection, fungal, Pseudomonas aeruginosa, Staphylococcus aureus, Candida and aspergillus, dermatological conditions, humidity
otitis externa RF
mild trauma, frequent cleaning, alterations in the microbiome of the ear canal, swimming, Q-tip use
Otitis Externa sx
Tender swollen ear canal
Auricle very tender to manipulation
Pruritus
Pain
Aural fullness and conductive hearing loss
One-sided or bilateral
Insomnia
Otitis Externa PE
Red ear canal
Exudate
May be swollen shut
Fever
Pain with manipulation of auricle and tragus
Otitis Externa Tx
- Dry ear
- Clean ear canal with loop or cotton swab
- If the eardrum is visualized and intact, gentle irrigation with 1:1 dilution of 3% hydrogen peroxide at body temperature
- Botanical eardrops: calendula, hydrastits, verbascum, hypericum 4-6 gtt, q 24
- Otic Domeboro solution: acidify ear canal
- Antibiotics: persistent or the patient’s temperature is higher than 38.3°C (101.0°F), if the pain is severe, regional lymphadenopathy is present in the preauricular or posterior cervical chains. Patients with diabetes or those taking systemic corticosteroids are more likely to need systemic treatment
- Cervical spine manipulation
- Lymphatic massage
- Hepar sulph
Fungal cause
* Tea tree oil 1:10 for aspergillus
* Nystatin
* Clotrimazole
* Tolnaftate
otitis media Tx
Diet lifestyle
Botanical
HP:
Hydrotherapy
Lymphatic massage
Craniosacral
Osteopathic thoracic pump
Cervical spine manipulation
Antibiotics: Amoxicillin and Cefdinir
Antihistamines
otitis media complications
Mastoiditis
Meningitis
Perforation of tympanic membrane
Cholesteatoma
Chronic suppurative otitis media
Streptococcus Pneumonia otitis media
causes more severe sx
Haemophilus Influenzae
will cause conjuncitvits and otitis media
Chronic suppurative otitis media
chronic infection of the middle ear and mastoid (mastoiditis), a non-intact tympanic membrane (because of perforation or tympanostomy tube), and discharge (otorrhea) that has been refractory to treatment for more than 6 weeks
Chronic suppurative otitis media cause
P. aeruginosa and S. aureus
otitis media diagnosis
buldging of the tympanic membrane
cloudy tympanic membrane
impaired mobility of the tympanic membrane
red tympanic membrane
Chronic Suppurative Otitis Media tx
oral antibitoics
treat zinc, slenium, calcium, Vit d, and iron defiecnies
aural toilet
are antibitoics useful in treating otitis media?
no unless they are in children younger than two years of age with bilateral AOM (infection in both ears), and in children with both AOM and otorrhea
Otitis Media with Effusion Tx
Diet
Supplementation: VIt C, Vit D, Vit A, fish oils, zinc picolinate, Beta carotene, EFAs, NAC, xylitol, Lumbrokinase and Nattokinase
Adenoidectomy
Botanical
* curcuma, inula, echinacea, larix, ligusticum,
* Verbascum, euphrasia, and glycyrrhiza
* Sambucus
* Salvia
* Bupleurum
HP: Calc carb, Medorrhinum, Silica, Lyc, Tub, Pulsatilla
Eustachian tube massage
Modified muncie technique
Auto-inflation: blowing balloon through with nostril
Educate and eliminate passive smoke (even 3rd hand)
No supine bottle feeding - Slant board at 25º for bottle feeding
Encourage breast-feeding
Surgery: Grommets
Antihistamines
Oral or intranasal steroids
Antibiotics
patulous eustachian tube cause
May be caused by damage to the tensor veli palatini. The tissue of the Torus Tubarius can shrink due to weight loss (colitis/cancer) or high estrogen states
Patulous Eustachian Tube sx
Fluctuating aural fullness
Tinnitus synchronous with respiration
Autophony
Patulous Eustachian Tube PE
Abnormal mobility of the TM synchronous with breathing
Tympanometry and AC audiology show saw-toothed
Patulous Eustachian Tube management/tx
Increasing hydration
Saline nasal drops
supersaturated potassium iodide
Surgery
Injections of gelfoam or autologous fat
Hydrastis canadensis part used
root, rhizome, leaf
Hydrastis canadensis action
Astringent, antimicrobial, bitter, mild stimulant
Hydrastis canadensis indications
Diarrhea, Used as a tonic for boggy, ulcerated or cracked mucous membranes with mucopurulent discharge. Used topically for conjunctivitis, otitis externa, otitis media, pharyngitis, rhinitis, and sinusitis.
Hydrastis canadensis CI
Neonates, pregnancy due to potential to simulate the uterus
Has to come in contact with the tissue to have its effects
Echinacea spp part used
root, rhizome, whole plant
Echinacea angustifolia actions
immunostimulator, anti-inflammatory, antimicrobial, stimulates leukocytes, inhibits hyaluronidase, enhances phagocytosis, stimulates fibroblasts, lymphagogue, vulnerary
Echinacea angustifolia indications
Infection, sepsis, pharyngitis, prevention of upper respiratory infections, snake bites, ulcers
Echinacea angustifolia CI
avoid prolonged use in inflammatory autoimmune diseases.
Echinacea pallida part used
root, rhizome, whole plant
Echinacea pallida actions
immunostimulator, anti-inflammatory, antimicrobial, stimulates leukocytes, inhibits hyaluronidase, enhances phagocytosis, stimulates fibroblasts, lymphagogue, vulnerary
Echinacea pallida indications
Infection, sepsis, pharyngitis, prevention of upper respiratory infections, snake bites, ulcers, influenza
Echinacea pallida CI
avoid prolonged use in inflammatory autoimmune diseases
Echinacea purpurea part
root, rhizome, whole plant
Echinacea purpurea actions
immunostimulator, anti-inflammatory, antimicrobial, stimulates leukocytes, inhibits hyaluronidase, enhances phagocytosis, stimulates fibroblasts, lymphagogue, vulnerary
Echinacea purpurea indications
Infection, sepsis, pharyngitis, prevention of upper respiratory infections, snake bites, ulcers
Echinacea purpurea CI
avoid prolonged use in inflammatory autoimmune diseases.
Eupatorium perfoliatum part used
Aerial part in bud or flower
Eupatorium perfoliatum actions
Stimulating diaphoretic, cholagogue and choleretic, diuretic, antispasmodic, laxative, emetic, imunostimulant, mucous membrane tonic, anti-inflammatory, cytotoxic (anticancer), bitter, febrifuge, peripheral circulatory stimulant, smooth muscle relaxant
Eupatorium perfoliatum indications
Flu-like illnesses with pain that sets into the bone (boneset), dengue fever
Eupatorium perfoliatum CI
Allergic hypersensitivity resulting in contact dermatitis, pregnancy, Diarrhea with to much
Baptisia tinctora part
root
Baptisia tinctora actions
Immunostimulant, antimicrobial, febrifuge
Baptisia tinctora indications
infections, protracted fever with severely depressed vital force, ulceration of tissue.
Baptisia tinctora CI
Large doses are toxic due to phenolic glycosides and
alkaloids – 30g induces signs of toxicity
Ginkgo biloba parts
Leaf
Ginkgo biloba actions
Increases blood flow to brain and periphery, antioxidant, anti-inflammatory, antithrombotic (antagonizes PAF), benefits cognition
Ginkgo biloba indications
Cerebrovascular insufficiency
Impaired mental performance
Migraines
TInnitus, vertigo
Diabetic retinopathy
Macular degeneration
Intermittent claudication
Raynaud’s phenomenon
Diabetic ulcers
Varicose veins
Erectile dysfunction
Altitude sickness
Ginkgo biloba CI
Pregnancy
Hemophilia
Use of blood thinning medications
Sambucus nigra part
flower, berry
Sambucus nigra actions
Influenza, colds, cough
Berries – antiviral, immunostimulant
Flowers – diaphoretic, diuretic, expectorant, nervine
Sambucus nigra indications
influenza, colds, cough, herpes infection/recurrence
Sambucus nigra CI
The unripe fruit, seeds, bark, leaves and root can cause diarrhea, nausea, vomiting, dizziness, tachycardia, and convulsions. Preparations of the berries should be cooked to avoid a cyananide-like toxicity.
Usnea spp part
whole plant
Usnea spp actions
Moderate astringent and hemostatic, strong antimicrobial, mild relaxant to smooth muscle, immunomodulating (stimulating), breaks down biofilms, synergistic potentiation of clarithromycin,
Usnea spp indications
Microbial infections, weight loss,respiratory infections, cutaneous infections, urinary tract infections
Usnea spp CI
Pregnancy
Cautions: May cause contact dermatitis., absorbs heavy metals or air pollution, so it should only be collected in pristine areas.
Toxicity: Purified usnic acid found to be hepatotoxic
Verbascum thapsus part
leaf
Verbascum thapsus actions
Expectorant, antimicrobial, demulcent, anodyne
Verbascum thapsus indications
Dry, hacking coughs or wet, productive coughs (amphoteric), Soothing agent in Otitis media and other irritations of the tympanic membrane and EAC
