ear infections, allergic rhinitis Flashcards
(51 cards)
1
Q
heat and moisture lead to swelling and maceration of the skin in the EAC; breakdown of skin allows bacteria to enter
Clinical presentation:
- ear pain, worse with movement of the external ear; pruritis; discharge
- EAC may be erythematous and edematous
- may have decreased hearing
- TM may or may not be intact
A
otitis externa : “swimmer’s ear”
2
Q
etiology of otitis externa
A
- psueomonas (38%)
- step epidermidis (9%)
- staph aureus (8%)
- fungal: asperigillus or candida albicans (2-10%)
3
Q
treatment of fungal otitis externa
A
- clotrimazole 1% solution BID x 14 days
- acidifying solution (acetic acid)
4
Q
treatment of bacteria otitis externa
A
- cortisporin otic suspension (polymixin B; Neomycin; Hydrocortisone) ** avoid is suspected TM perforation
- Floxin otic: indicated for perforated TM
- Use ear wick: if marked swelling of EAC; remove wick after 2-3 days and continue meds as directed
5
Q
management of otitis externa (things to do other than medication)
A
- pain control
- keep canal dry (no swimming 7-10 days)
- most cases resolve within 5-7 days: if not, consider fungal infection
- prevention: 2% acetic acid to acidify the EAC
6
Q
what population is susceptible to malignant otitis externa? what organism causes it?
A
- seen in diabetics and immunocompromised
- pseudomonas in 95% of cases
* complications: osteomyelitis; meningitis; mortality
7
Q
clinical presentation
- intense ear pain and otorrhea (discharge)
- red, granulation tissue in EAC
- possible periauricular lymphadenopathy, edema and trismus (spasm of jaw muscle)
- elevated ESR or CRP
A
malignant otitis externa
8
Q
treatment for malignant otitis externa
A
- admit
- IV Ciprofloxacin
9
Q
peak incidence of acute otitis media. Why?
A
- 6-18 months old
- usually precipitated by a viral URI; eustachian tube becomes obstructed with fluid and mucus; accumulated fluid become sedentary
- horizontal eustachian tube allows for migration of organisms from nasopharynx
- enlarged adenoids prevent adequate drainage
10
Q
most common pathogens of acute otitis media
A
- streptococcus pneumoniae (40-50%)
- haemophilus influenzae (45%)
- moraxella catarrhalis (10%)
11
Q
predisposing risk factors of acute otitis media
A
- age and immature anatomy in children
- secondhand smoke
- day care
- use of pacifier
- season (fall/winter)
12
Q
clinical presentation for pediatric patient
- irritability
- decreased appetite
- +/- fever
- tugging on ear
- hearing loss
- may also see conjunctivitis, rhinorrhea, ear dx, vomiting, and diarrhea
A
acute otitis media
13
Q
clinical presentation in adult
- otalgia
- rare to have fever
- opaque or reddened TM
- bulging TM
- decreased TM mobility
A
acute otitis media
14
Q
otitis media: criteria for diagnosis of children 6 mo -12 years
A
- moderate to severe bulging of the TM OR
- new onset of otorrhea not due to acute OE OR
- mild bulging of TM and recent ear pain ( <48 hr) or intense erythema of the TM
15
Q
tympanometry
A
quantitative measure of acoustic impedance
- compliance or resistance of the middle ear in response to changes in air pressure
- probe inserted into ear canal to deliver positive and negative pressure
16
Q
type of tympanogram. what conditions will cause this
A
- type B: little or no mobility
- fluid or TM perf
17
Q
type of tympanogram. what conditions will cause this
A
- type C: retracted
- eustachian tuve dysfunction
18
Q
you should trea of Acute otitis media with Abx under what conditions
A
- < 6 months
- 6-23 months: severe signs/symptoms or bilat AOM
- >24 months: if diagnosis is certain and illness is severe
** severe: moderate or severe otalgia, otalgia for > 48 hrs; temperature above 102.2F
19
Q
you can treat acute otitis media with abx or observation with close follow up (48-72 hrs) if?
A
- 6-23 months: non severe unilateral AOM
- > 24 months: non-severe unilateral or bilat AOM
20
Q
treatment of acute otitis media
A
amoxicillin 80-90 mg/kg/day (q 12 hrs) x 7-10 days
**should not be used in kids who are at high risk of AOM caused by resistant organism
21
Q
what puts a kid at high risk of AOM caused by resistant organism
A
- abx in last 30 days
- concurrent purulent conjunctivitis
- hx of recurrent AOM resistant to amoxicillin
22
Q
treatment for high risk of AOM caused by resistant organism
A
- amoxicillin/clavulanate = Augmentin
- 90mg/kf amoxicillin and 6.4 mg/kg clavulanate
- do not use if PCN allergy
- omnicef
23
Q
should OTC cold preparations be used in children under 4 yo
A
no
24
Q
how should you treat a recurrent acute otitis media
A
- IM rocephin (ceftriaxone)
- augmentin
- consider need for tympanostomy tubes if 3 or more episodes in 6 months
25
when does otitis media become Chronic
* drainage from middle ear \> 2 weeks
* associated with TM perforation that is usually painless (conductive hearing loss)
26
clinical presentation
* +/- pain, otorrhea
* associated with acute or chronic OM
* conductive hearing loss
* no movement with pneumatic otoscopy
* vertigo
TM perforation
\*\* most heal spontaneously
27
clinical presentation
* extension of OE or AOM into mastoid air cells
* postauricular pain, edema and erythema
* protrusion of pinna
* fever
* deep temporal pain
mastoiditis
tx: IV abx; ENT consult
28
etiolofy of otitis media with effusion (OME)
* middle ear effusion secondary to inflammation or eustachian tube dysfunction
* following a viral URI; AOM; or in association with allergic rhinitis
29
clinical presentation
* afebrile
* amber-colored (straw) fluid behind TM
* may see air fluid level and bubbles
* neutral or retracted TM
* conductive hearing loss
* tympanogram type B
otitis media with effusion (OME
30
if you have an adult patient with persistent **unilateral** otitis media with effusion, what must you do
refer to ENT to r/o nasopharyngeal carcinoma
31
management of otitis media with effusion (OME)
* "watchful waiting"; reevaluate 4-6 weeks
* intranasal steroids in underlying allergic rhinitis
32
when would you present a patient with otitis media with effusion (OME) to ENT for T-tubes
* persistent fluid and/or hearing loss \> 3 months duration
33
clinical presentation
* inflammation or blockage resulting in negative middle ear pressure
* ear fullness, hearing loss
* retracted TM; prominent bony landmarks
* type C tympanogram
eustachian tube dysfunction
34
treatment of eustachian tube dysfunction
1. steroid nasal spray; decongestant
2. topical nasal decongestant
* phenylephrine (neo-synephrine) or oxymetazoline (Afrin)
* limit therapy to 3 days to avoid rebound congestion
35
clinical presentation
* discomfort or damage to ear due to pressure differences (associated with altitude changes)
* ear fullness; pain; tinnitus
* bloody otorrhea if TM perforation
ear barotrauma
36
treatment for barotrauma
supportive
37
what is labyrinthitis
* benign, acute infection or inflammation of vestibular system
* most commonly associated with viral infection
* seen commonly in 30-60 yo
38
clinical presentation
* acute onset of severe vertigo, 1-2 days duration
* N/V
* tinnitus and/or unilateral hearing loss. No CNS deficits
* (+) head thrust: cannot maintain visual fixation
* horizontal nystagmus
labyrinthitis
39
treatment of labyrinthitis
symptomatic
* bed rest; hydration
* treatment of N/V: meclizine (antivert) 25 mg TID
* benzodiazepines
40
perennial rhinitis
occurs year round: usually due to dust mites, mold, animal dander
41
clinical presentation: exam finding
* nasal speculum exam: pale, **blue** mucosa, boggy; clear discharge
* eyes and periorbital: palpebral conjunctiva may be pale, swollen
* allergic shiners
* denie morgan lines: skin folds under eyes
allergic rhinitis
42
treatment for allergic rhinitis
topical intranasal corticosteroids
* beclomethasone (beconase)
* Triamcinolone (Nasacort): OTC
43
treatment for allergic rhinitis: specific symptoms of sneezing, rhinorrhea, and itching
antihistamines: first generation
* chlorpheniramine 4mg q4-6 hr or 8-12 mg BID for sustained release
* Diphenhydramine (Benadryl) 25-50 mg BID-TID
\*\*side effects: dry mouth, constipation, sedation
44
benefit of second generation antihistamines for treatment of allergic rhinitis
less sedating
* claratin 10 mg daily
* Allegra 60 mg BID
* Zyrtex 5-10 mg daily
45
treatment for allergic rhinitis: specifically nasal congestion
decongestant: causes vasoconstriction
pseudoephredrine (sudafed) 30-60 q 6-8 hr or 120 mg BID for SR
\*\*\* caution flag: HTN, cardiac disease
46
last resort treatment for allergic rhinitis
immunotherapy: hyposensitization
* stimulates production of IgG against allergens
* success rate 85%
47
* abnormal autonomic responsiveness triggered by stress, sexual arousal, ciggs, temp changes or anti-HTN medication
* nasal congestion and rhinorrhea
* no itching or sneezing
* nasal mucosa is normal; IgE normal
perennial non-allergic (vasomotor) rhinitis
48
treatment of perennial non-allergic (vasomotor) rhinitis
* avoid triggers
* topical steroids
* topical antihistamines (azelastine)
* topical anticholinergics
49
treatment of nasal polyps
\*\* commonly seen with allergic rhinitis, vasomotor rhinitis
intranasal glucocorticoids
refer to ENT for obstruction
50
* see tachyphylaxis (diminished response of drug) with overuse of topical decongestants
* what is the condition when you see severe rebound congestion after stopping topical decongestant?
* nasal mucosa is erythematous
rhinitis medicamentosa
\*\*treatment: stop medication and treat with intranasal glucocorticoid
51
treatment of otitis media after treatment failure
IM rocephin (ceftriaxone) 50 mg IM or IV once daily for 3 days
