Ear infections x2

Question 1

Otitis Externa cause

Answer 1

swimmers ear

• trauma or associated skin disease
• Bacterial* most common*: pseudomona, staph
• Fungal

Question 2

Otitis Externa Presentation

Answer 2

Otalgia- push on tragus/ pull on pina
pruritis
discharge 
- green: pseudomonas
-yellow- staoh
- fungal: flffy, white, or black
-erythema and edema of canal and possiby decreased hearing

Question 3

Otitis externa Managment

Answer 3

• clean ear canal
• treat infection and inflammation
• contol pain NSIADs
• keep canal dry: no swimming and cotton in ear during bathing

Question 4

Otitis externa bactral managment

Answer 4

Cotisporin Otic
- supsension or solution
- DO NOT use if TM is perforatied
Floxin Otic
-solution 
- indicated if TM is perforated 
Ciprodexor CiproHC 
- suspension
- better for relief of edema and inflamation

Question 5

Ottis Externa fungal

Answer 5

Fungal injections

• Metifculus cleaning and Clotirimazole 1% BID x10-14days
• then acidifying solutions

Question 6

Prevention of ottis Externa

Answer 6

Acidifying solution in the ear
- drying the EAC
- if recurrent add bathing cap or ear plugs
With treatment it should reslve 5-7 days

Question 7

Malignant Otitis externa cause

Answer 7

• when infection spreads from EAC to temporal bone
  Risk: elderly DM
  cause: pseudomonas

Question 8

Malignant otitis ext presentation presentation

Answer 8

granulation tissue: pink shiny tissue.
Exquisite otalgia and not responsive to treatment
- pain is worse at night and when they chew**
may have trismus, lymphademopathy, edema
- watch for CN involment

Question 9

Malignant otitis Dx

Answer 9

^ ESR CRP (infm markers)
CT scan- show osteomyalitits and bone distruction
MRI: to check for the extent of the disease spread

Question 10

Malignant otitis Tx /comp

Answer 10

Admit to hospital and C&S ear discharge
- conduct culture and then provide antibiotic
- being with ciprofloxican
- change to oral when imrpoves
Comp: intracranial sprea

Question 11

Otitis Media types

Answer 11

1. Otitis media with infusion
   - no pus
2. Acute otitis media
   - will have pus
3. Chronic aotitis media
   - always have TM that isnt intact

Question 12

Otitis Media with Effusion (OME )

Answer 12

Etiology: reacent AOM
Middle ear fluid without signs of ilness or inflamation> ear fullness and decreased hearing usually painless
- can see air bubles
- neutral or retracted TM
- conductive hearing loss
- TM will not move with pneumatic otoscopy
*tympanogram Type B pattern

Question 13

OME managment

Answer 13

• ” watchful waiting”
  -possible T tibe palcement
  Refer: if longer than 3 months or at risk children

Question 14

Eustachian tube disfunction

Answer 14

Ondstuctive disfunction is most common> resulting in negative ear pressure
Sx: ear fullness, recurrent OME, hearing loss
Dx; retracted TM- prominant boney landmarks
Tympanogram type C

Question 15

Eustachian tube dis Tx

Question 16

ACUTE otitis media

Answer 16

purulent fluid, reddness, mastoid air cells are involved
peds: irritability, poor feeding, fever, ear paintugging on their ear. - may also see conjunctivitis, rihnorea, discharge.
Adults: otalgia and decreased hearing rarely a fever

Question 17

Acute otitis media risk

Answer 17

little kids 6-18 month old ( 2nd smoke, no breast feeding, use of pacifier, season)
- precipated by viral URI
- eustanchian tube becoms obstructed
Path: strep, haemophilus influenzarr, and moraxella catarrhalis

Question 18

AOM exam present

Answer 18

Bulging Tm- loss of landmarks and light reflex in dampended
erythema of TM
porr mobility- pneumatic otoscopy

Question 19

Bullous Myringitits

Answer 19

bulla forming

• from virus
• treat like AOM

Question 20

Diagnosis of AOM

Answer 20

6-12 mon

• buldign of TM, otorrhea not due to acute OE
• mild buldging and ear poin/ erythmea of TM

Question 21

AOM whether to treat

Answer 21

<6mo treat with abx 
all children :
- mod severe otalgia
- more than 48hrs
-temo > 102.2
<24 months old bilietral 

can chose if 6-23mon unilateral non severe, >24mon unilateral or bilateral non svere
** need close followup**

Question 22

AOM tx

Answer 22

1. Amoxixillin unless
   - 30 days, concurrent conjunctivitis, hx of recurrent AOm, if allergic to PCN

^ dose 90mg/kg/day every 12 hrs for 7-10 days
2nd line:
2. amoxicillin/clavulate(augmentin)
- 90mg/kg and 6.4 mg/kg clavulanate
3. if pcn allergy
- oral: cefalosporins
- if serois PCN reaction: azithromycin, clarithromycin clindamycins
Symptomatic relief: hydration and pain/fever managment. avoid cough and cold mediciens

Question 23

recurrent AOM

Answer 23

develop withing 30 days after sucsessful tx
<15 tx cetriaxion
>15days with augmentin
consid T tubes > 3epidsone in 6 months
>4 epi on 12 months

Question 24

Complications of AOM

Answer 24

conductive hearing loss
TM perforation
chronic otitis media 
typanosclerosis
cholesteatoma
mastoiditis 
acute labryrinthitis

Question 25

Tympanometry

Answer 25

quantitative measure of TM mobility - done by ENT of audiology A- normal B- little or no mobility usually becuase of fluid or TM perforation C: retracted- starting at neg point - eustacian tube disfunction

Question 26

TM perforations

Answer 26

+/- pain conductive hearing loss no movement with pneumatic otoscopy - vertigo means issue with inner ear

Question 27

Chronic otitis media

Answer 27

drainage from the middle ear > 2wkes and assocaited with TM perforation that is painless -etiology: recurrent AOM, pseudomona, MRSA, conductive ear loss Tx: refer to ENT

Question 28

Cholesteatoma

Answer 28

abnormal growth of squamous epithelium in middle ear/ astoid - caused by recurrent AOM - they can progressively large and destroy the ossicles

Question 29

Mastoiditis

Answer 29

``` Post auricular pain edeme and erythema> complication of AOM - flucutance or mass - fever - temporal pain - protrusion of penna Tx: IV antibiotics and ENT consults ```

Question 30

Labyrinthitis

Answer 30

Benign self limiting disorder of vestiular system - unilateral hearing loss is present * though to be becuae of virus* Prsent: acute onset, N/V, sudden vertigo, may have nystagmus +head thrust - no CNS deficits ( differnt from stroke!) Tx: symptomatic treatment - rest, hydration, 1 gen antihistamine (meclizine) -antiemetics- prochlorperazine