Ear

Question 1

Occurs when increased amounts of hard
cerumen partially or completely occludes the
ear canal
• Symptoms: decreased hearing, sensation of
pressure in ear canal

Answer 1

Cerumen Impaction

Question 2

How to tx Cerumen Impaction?

Answer 2

Use a commercial wax
softener (or baby/mineral oil) first. Then
use a cerumen spoon and or a Water Pik
or warm saline irrigation with a bulb
syringe.

Question 3

how to prevent cerumen impaction?

Answer 3

Prevention: Do not use Q-tips. Use soft cloths and soap to clean auricle; may use OTC ear wax drops.

Question 4

Symptoms: pain within the ear canal, pressure, or decreased hearing

Answer 4

Ear foreign body

Question 5

Skin infection of the external auditory canal- Pain with pressing on tragus

Answer 5

Otitis Externa

Question 6

Symptoms: pain of the ear and auricle which
occurs within a two-day time period in the last
three weeks; fullness or pruritus within the ear;
in some cases purulent exudate within the canal

Answer 6

Otitis Externa

Question 7

How to manage Otitis Externa if RM Intact ?

how to prevent

Answer 7

NSAIDS, if ™ intact, ear lavage, Ofloxacin/ Ciproflaxacin/ Dexamethasone
Prevenion: ear plugs with swimming, no scratching, hair dryer to ear,

Question 8

What should be used if the TM is not intact or its status cannot be determined visually?

Answer 8

Ofloxacin or ciprofloxacin/ dexamethasone (Ciprodex)

Otic drops are approved for middle ear use

Question 9

Indications for removing ear foreign body?

Answer 9

visible FB in external canal, proper equipment to assist with extraction, and a cooperative patient

Question 10

an acute infection
of the middle ear
• Common pathogens:
• S. pneumoniae
• Haemophilus influenzae
(non-typeable)
• M. catarrhalis

Answer 10

Acute Otitis Media

Question 11

1. Abrupt onset of symptoms: otalgia, irritability, otorrhea
2. Middle ear effusion confirmed by bulging TM, limited or decreased mobility, air-fluid level
3. Presentation of middle ear inflammation: erythematous TM, otalgia, symptoms interfere with activities

Answer 11

Acute Otitis Media

Question 12

How to Manage of AOM

Answer 12

Watchful waiting for 48-72 hours

Pain management (Tylenol or NSAIDS)
• Antibacterial therapy
• ENT referral if indicated
** Based on patient age and symptoms

Question 13

AAP recommendation for AOM Tx for 6 months to 2 years

Unilateral or bilateral with severe symptoms or Bilateral without Otorrhea

Answer 13

Amoxicillin 80–90 mg/kg/day divided bid 5–7 days

Amoxicillin/clavulanate 90 mg/kg/day divided bid: 10 days

Question 14

AAP recommendation for AOM Tx for ≥2 years

Unilateral or bilateral with severe symptoms or Bilateral without Otorrhea

Answer 14

Amoxicillin 80–90 mg/kg/day divided bid

Amoxicillin/clavulanate 90 mg/kg/day divided bid

Question 15

How to prevent AOM?

Answer 15

•Pneumococcal conjugate vaccine
• Influenza vaccine
• Breastfeeding: clinicians should encourage exclusive breastfeeding for at least six months
• Avoidance of tobacco smoke exposure
- avoid bottle propping and use of pacifiers after 6 months of age

Question 16

AAP tx recommendation for 6mo -2 years with Unilateral AOM without Otorrhea

Answer 16

Antibiotic therapy or

additional observation

Question 17

AAP tx recommendation for ≥2 years with Unilateral or bilateral AOM without
Otorrhea

Answer 17

Antibiotic therapy or

additional observation

Question 18

What med can you use to tx AOM for pts with penicillin allergy?

Answer 18

Cefdinir

Question 19

What is considered to be recurrent AOM?

Answer 19

3 or more infections within a 6 month period or 4 or more infections in 12 months… with one episode occurring within the last 6 months

Question 20

Causes of TM perforation?

Answer 20

child who has had AOM- most common

Blast injury or Barotrauma
cholesteatoma (rare)

Question 21

Tx plan for TM perforation?

Answer 21

Check hearing!!
Avoid ototoxic drugs
Keep ear dry (wear earplugs when in h2o)

… dont use standard drops because they can get into middle ear and be dangerous- only use suspension format drops

Question 22

When to refer TM perforation ?

Answer 22

refer of perforation is not healing… typically takes 3-4 weeks after infection, longer for trauma

refer pts that already have hearing problems

Question 23

How does a ruptured TM from Blast injury or Barotrauma present?

Answer 23

persistent pain and hearing loss

Question 24

How does a ruptured TM from child with AOM?

Answer 24

pain’s going to be gone as soon as the rupture happens

Question 25

Serous fluid in middle ear with no S/S infection or inflammation Might present before or after an ear infection but can occur spontaneously More common in children and those with a cleft palate or Down syndrome

Answer 25

Otitis Media With Effusion (OME)

Question 26

Causes of Otitis Media With Effusion (OME)?

Answer 26

Caused by a build-up of fluid in the middle ear, usually due to Eustachian tube dysfunction (swelling) •Can result from acute otitis media (AOM), viral infection, allergies, anatomical abnormalities •Can be chronic (known as serousotitis media)

Question 27

Common presentation of Otitis Media With Effusion (OME)?

Answer 27

Patient might complain of muffled sounds, “talking in a drum,” popping noises Sometimes patient will complain of otalgia (ear pain) Afebrile Might complain of hearing loss

Question 28

Physical exam findings with Otitis Media With Effusion (OME)?

Answer 28

TM may be full or retracted Decreased TM mobility •TM often described as “dull”, may see bubbles posteriorly *Should not be bulging or red*

Question 29

common differentials with Otitis Media With Effusion (OME)?

Answer 29

Acute otitis media Chronic otitis media Otitis externa Foreign body in the ear canal

Question 30

How to tx Otitis Media With Effusion (OME)?

Answer 30

Symptomatic (analgesics—if needed, antihistamine—if allergic component) •Do NOT use antibiotics •not recommend oral or intranasal steroids, decongestants, or antihistamines to treat •Avoid secondhand smoke; avoid pacifiers during the day if over 12 months old •Monitor for any hearing loss and/or developmental delays- > ENT

Question 31

prognosis for Otitis Media With Effusion (OME)? how long to typically heal?

Answer 31

Majority will resolve on their own over three months May need ENT referral for possible tube placement

Question 32

``` Bacterial infection of the mastoid cells •Results from unresolved OM •Presents with fever, irritability, lethargy •Swelling around the ear •Redness and tenderness behind the ear- POSTAURICULAR SWELLING •Drainage from the ear •Bulging and drooping of the ear •6–13 months ```

Answer 32

Mastoiditis

Question 33

H&P for Mastoiditis

Answer 33

* Recent OM? * Treatment for OM? * All medication taken? * Fever, malaise, tenderness? * Dental care? * N/V/D? * Vision changes? * VS * Inspection of area * HEENT Exam * Cardiac and lung

Question 34

Diagnostics and Treatment for Mastoiditis

Answer 34

URGENT ENT referral → hospitalization with IV ABX (cephalosporins and dexamethasone) and surgical intervention required (I&D and culture) Send for CT scan

Question 35

blunt trauma causes tears in blood vessels leading to hematoma. Hematoma stimulates cartilage formation resulting in deformity. Auricular tenderness and swelling, Blood on outside of ear, Erythema or ecchymosis to overlying skin Refer to otolaryngology within 7 days of trauma to prevent cartilage growth

Answer 35

Auricular Hematoma: “wrestler’s ear” or cauliflower ear

Question 36

inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after ABX tx

Answer 36

Tympanostomy Tubes

Question 37

1st line choice of abx tx for AOM

Answer 37

Amoxicillin 80-90mg/kg/day BID

Question 38

Good when a child has both AOM + conjunctivitis, was treated with amox in the last 30 days or is allergic to penicillins. This medication is more costly and can cause more diarrhea.

Answer 38

Amoxicillin/Clavulanate (Augmentin) 80-90mg/kg/day BID

Question 39

Choice of abx tx for PCN allergy for AOM

Answer 39

Cefdinir

Question 40

Recommended if there is tympanic membrane perforation (as they are not ototoxic), draining pressure equalizer (PE) tubes or there is otorrhea.

Answer 40

-Ototopical antibiotics drops: 1-Ofloxacin 2- Ciprofloxacin/ Dexamethasone (Ciprodex)

Question 41

Recommended if there is tympanic membrane perforation (as they are not ototoxic), draining pressure equalizer (PE) tubes or there is otorrhea.

Answer 41

-Ophthalmic antibiotic drops: 1-Tobramycin 2-Gentamicin

Question 42

2 week hx of severe itching and tearing of both eyes. redness. swelling of eyelids, along with stringy, mucoid discharge. What to prescribe?

Answer 42

Topical NSAID Drops | Conjunctivitis

Question 43

Child with PET tubes in both ears with mild otalgia in one ear- able to visualize the tube and no exudate in ear canal - type A tympanogram obtained

Answer 43

Order ototopical antibiotic/ corticosteroid drops

Question 44

resembles a teepee and shows a normal middle ear system that has no fluid and an intact tympanic membrane. It also indicates the absence of any kind of physiological anomalies that usually prevent the entrance of sound into the cochlea from the middle ear.

Answer 44

type A tympanogram