ENT Flashcards
(15 cards)
Q1: What is the mainstay of treatment for acute otitis media (AOM)?
A1: Adequate and regular analgesia is the mainstay of treatment for acute otitis media. Antibiotic therapy can be safely withheld for most children.
Can give delayed prescription if does not resolve in 48-72 hours.
Q2: In which groups of children is antibiotic therapy required for acute otitis media? (8 points)
A2: Antibiotic therapy is required for:
Infants younger than 6 months.
Children younger than 2 years with bilateral infection.
Children who are systemically unwell (e.g., lethargic, pale, very irritable).
Children with any otorrhoea (suppurative OM).
Children at high risk of complications (e.g., immunocompromised children).
Only hearing ear
Cochlear implant
Some Aboriginal and Torres Strait Islander children:
- Living in remote communities
- <2 years of age
- First episode otitis media <6 months of age
- Persistent OME
- Current bilateral AOM without perforation
- Current AOM with perforation
- Current chronic suppurative otitis media (CSOM)
- History of recurrent AOMwoP & AOMwiP, CSOM
- Family history of CSOM
- Craniofacial abnormalities/ cleft palate/ Down’s syndrome/ developmental delay/ hearing loss/ visual impairment
Q3: What is the recommended antibiotic regimen for acute otitis media if antibiotics are indicated?
A3: The recommended antibiotic regimen is:
Amoxicillin 15 mg/kg up to 500 mg orally, 8-hourly for 5 days.
If adherence to an 8-hourly regimen is unlikely, use amoxicillin 30 mg/kg up to 1 g orally, 12-hourly for 5 days.
(Allergy to penicillin use cefuroxime (1) for trimetoprim + sulfamethaxozole (2))
Q4: What should be done if a child with AOM does not respond to amoxicillin therapy within 48 to 72 hours?
A4: If a child does not respond to amoxicillin therapy within 48 to 72 hours, consider adding clavulanate to amoxicillin to treat potential beta-lactamase-producing strains of Haemophilus influenzae or Moraxella catarrhalis. Use amoxicillin+clavulanate 22.5+3.2 mg/kg up to 875+125 mg orally, 12-hourly for 5 to 7 days.
Q5: What is the management approach for a child with a tympanic membrane perforation and otorrhoea?
A5: For a child with a tympanic membrane perforation and otorrhoea, prescribe oral antibiotics. If no resolution in 7 days start oral augmentin and topical ciprofloxacin 0.3% ear drops, 5 drops instilled into the affected ear, 12-hourly until the middle ear has been free of discharge for at least 3 days.
Q6: What are the potential harms of antibiotic therapy in children with acute otitis media?
A6: The potential harms of antibiotic therapy include:
Adverse effects such as diarrhea, rash, or more serious hypersensitivity reactions.
Disruption of the balance of bacteria in the body (the microbiome), which can lead to yeast infections or more serious infections like Clostridium difficile infection.
Development of antibiotic resistance, making future infections harder to treat.
Q9: What is the difference between acute otitis media (AOM) and otitis media with effusion (OME)?
A9:
Acute otitis media (AOM) is characterized by acute inflammation of the middle ear with symptoms such as ear pain, fever, and a bulging tympanic membrane.
Otitis media with effusion (OME) involves fluid in the middle ear without symptoms or signs of acute inflammation. OME is often a residual effusion that remains after an episode of AOM.
Q11: What are the complications of untreated or poorly managed acute otitis media?
A11: Complications include:
Tympanic membrane perforation.
Mastoiditis.
Cholesteatoma.
Facial nerve palsy.
Hearing loss (if otitis media with effusion persists).
Meningitis.
Q15: What is the recommended follow-up for a child with acute otitis media?
A15: Follow-up recommendations include:
Reviewing the child in 2-3 days if symptoms do not improve.
Reassessing the child at 4-7 days to ensure resolution of symptoms.
Advising parents to seek medical review if ear symptoms, hearing difficulty, or persistent irritability occur after 2-3 months.
Q: What is acute mastoiditis, and how is it diagnosed?
Acute mastoiditis is a rare but serious suppurative complication of acute otitis media (AOM) and may be associated with intracranial complications.
Diagnosis is based on:
Post-auricular inflammatory signs (erythema, edema, tenderness, or fluctuance).
Protruding auricle or external auditory canal edema.
Signs of AOM (e.g., bulging tympanic membrane, otalgia).
What is the treatment for acute mastoiditis?
Prompt treatment with appropriate intravenous antibiotics:
Flucloxacillin plus a 3rd-generation cephalosporin.
ENT involvement is required for management.
What are the key clinical signs of acute mastoiditis?
Post-auricular inflammatory signs: erythema, swelling, pain, or fluctuance.
Protruding auricle or external auditory canal edema.
Signs of AOM (e.g., bulging tympanic membrane, otalgia).
What is rinnes and webbers test?
Rinne Test
Purpose: Compares air conduction (AC) and bone conduction (BC) of sound.
How it’s done:
Place a vibrating tuning fork (typically 512 Hz) on the mastoid bone (behind the ear) to test bone conduction.
When the patient no longer hears the sound, move the tuning fork near the ear canal to test air conduction.
Ask the patient which is louder or if they can still hear the sound.
Interpretation:
Normal hearing (or sensorineural hearing loss):
AC > BC: Air conduction is better than bone conduction (Rinne positive).
Conductive hearing loss:
BC > AC: Bone conduction is better than air conduction (Rinne negative).
Weber Test
Purpose: Determines lateralization of sound (which ear hears the sound better).
How it’s done:
Place a vibrating tuning fork (512 Hz) on the midline of the forehead or vertex of the skull.
Ask the patient which ear hears the sound louder or if it is heard equally in both ears.
Interpretation:
Normal hearing:
Sound is heard equally in both ears (no lateralization).
Conductive hearing loss:
Sound lateralizes to the affected ear (the ear with the conductive loss hears it louder).
Sensorineural hearing loss:
Sound lateralizes to the unaffected ear (the ear with the sensorineural loss hears it less or not at all).
What is the difference between labyrinthitis and vestibular neuritis?
Vestibular neuritis
Acute vertigo + nausea+ vomiting
Acute labyrinthitis
Above and hearing loss +- tinnitus
What is the diagnosis for the following vertigo symptoms?
- Constant vertigo, no hearing loss, positive HINTS for peripheral cause
- Episodic, positional vertigo triggered by head movements, no hearing loss
- Episodic vertigo with hearing loss, tinnitus, and ear fullness
- Constant vertigo, no hearing loss, positive HINTS for peripheral cause, with unilateral hearing loss
- Central neurological signs, abnormal HINTS exam, often vascular risk factors for migraines
Constant vertigo, no hearing loss, positive HINTS for peripheral cause
Episodic, positional vertigo triggered by head movements, no hearing loss
Episodic vertigo with hearing loss, tinnitus, and ear fullness
Similar to vestibular neuritis but with unilateral hearing loss
Central neurological signs, abnormal HINTS exam, often vascular risk factors for migraines
Vestibular Neuritis: Constant vertigo, no hearing loss, and a positive HINTS exam for peripheral causes.
BPPV: Episodic, positional vertigo triggered by head movements, no hearing loss.
Meniere’s Disease: Episodic vertigo with hearing loss, tinnitus, and ear fullness.
Labyrinthitis: Similar to vestibular neuritis but includes unilateral hearing loss.
Central Causes: Associated with neurological deficits, abnormal HINTS exam, and often vascular risk factors or migraines.
