ENT2 Flashcards

Question

What is meant by the term otitis media

Answer 1

Term referring to all forms of inflammation and infection in the middle ear

Answer 2

Presence of **fluid** behind the ear **WITHOUT acute symptoms** -eg glue ear A **type B tympanogram** or **reduced mobility of eardrum on pneumatic otoscopy** are best ways of diagnosing OME

Answer 3

Presence of fluid in the ear for **more than 3 months** with **no** symptoms or signs of inflammation

Answer 4

Term which covers acute OM with and without perforation. Defined as: 1. PRESENCE OF FLUID BEHIND EARDRUM PLUS one of: * **bulging ear drum** * red eardrum * **recent discharge of pus** * fever * **ear pain** * irritability

Answer 5

PRESENCE OF FLUID BEHIND EARDRUM PLUS one of: **bulging ear drum** red eardrum fever **ear pain** irritability

Answer 6

Discharge of pus through a hole in the eardrum in the last **6 weeks**

Answer 7

3 or more episodes of AOM in 6 months or 4 or more episodes of AOM in 12 months

Answer 8

**Persistent discharge** through a hole in the Tympanic membrane (between 2 to 12 weeks) CSOM is diagnosed only when perforation is seen and big enough to allow the fluid to flow out of the middle ear space

Answer 9

All ATSI children require antibiotics for OM Use **Amoxil 25mg/kg BD** (max 1g) for 7 days (can also give stat dose of _azithromycin 30mg/kilos_) if adherence difficult or no fridge) Review in one week - if persistent bulging Increase to **45mg/kg** for 7 days or second azithro dose/ Review weekly till resolution then 3 monthly

Answer 10

**Dry aural toilet** - remove pus from canal by **dry mopping** with tissue and/or syringe with dilute betadine solution Use **Amoxil 25mg/kg BD (max 1g) for 7 days** (can also give stat dose of azithromycin 30mg/kilos) if adherence difficult or no fridge) Review in one week - if discharge or persistent bulging: Increase to **45mg/kg for 7 days** or second azithro dose/ **ADD - ciprofloxacin (0.3%)** ear drops 5 drops bd after dry mopping **Weekly follow up (use recall system)** If discharge persists after two weeks through a visible perforation - Educate carers regarding Chronic supprative otitis media swab M/C/S Ongoing dry aural toilet ciprofloxacin ear drops If not improved by 1-2 months Refer ENT

Answer 11

1. Oral Amoxicillin 15mg/kilo up to 500mg TDS for five days. 2. Review in 48 hours 3. If not responding change to Amoxicillin + Clavulanate 22.5 + 3.2mg/kilo up to 875/125 orally BD for five days 4. Review in 2 weeks or sooner if unwell 5. Safety netting: If deteriorates immediate referral to Emergency department

Answer 12

Oral **Amoxicillin 15mg/kilo up to 500mg TDS** for five days. **Dry Aural Toilet** **Ciprofloxacin 0.3% drops** - **five drops** to affected ear **twice daily** until middle ear free of discharge for three days Safety netting - review in 48 hours if deterioration or if becomes systemically unwell go to ED. If not responding **after one week** change to **Amoxicillin + Clavulanate 22.5 + 3.2mg/kilo up to 875/125 orally BD** for seven days Continue **dry Aural toilet and Ciprofloxacin drops** If becomes systemically unwell at any point --\> ED if **persistent discharge at 6 weeks - Refer to ENT** specialist for further evaluation of Chronic supprative otitis media

Answer 13

Any **infants under 6 months** **Kids under 2 years with BILATERAL** infection Children who are **systemically unwell** (lethargy, pallor, irritable) fever alone is not sufficient children with **ottorhea** **Aboriginal and Torres Strait Islander** children Children at **high risk** of complications (Eg immunocompromise)

Answer 14

1. Educate caretakers/patient about natural history of disease and likely aetiology. 2. Prescribe **paracetamol 15mg/kg** max 1g qid And/or **Ibuprofen 10mg/kg** up to max 400mg TDS 3. Review in 48 hours - if symptoms have progressed 4. Oral **Amoxicillin 15mg/kilo up to 500mg TDS for five days**. 5. Review in 48 hours 6. If not responding change to **Amoxicillin + Clavulanate 22.5 + 3.2mg/kilo up to 875/125 orally BD** for five days 7. Review in two weeks. 8. Safety net - if becomes systemically unwell transfer to Emergency department for specialist review

Answer 15

Pain relief with NSAID rest in humid room Avoid swimnming and flying (no cotton buds) Review in 48 hours and then in 1-2 weeks Consider vaccination against influenza and/or pneumococcal

Answer 16

Otoscopy, tympanometry +/\_ hearing test All parents should be advised to see doctor if hearing probs, discharge or irritability persist for 3 months

Answer 17

1. **Recurrent (**3 in 6months/4 in 12 months 2. **Persistent ear effusion over 3 months** with a) hearing loss b) behavioural issues c) with TM damage. 3. **Persistent ear discharge over 6 weeks** 4. **Complications** - eg mastoiditis, hearing loss, not improving on antibiotics,

Answer 18

Strep. pneumoniae Haem influenzae Moraxella Catarhallis

Answer 19

Age - esp **6-11months** Race - **ATSI** **Craniofacial** abnormalities (eg cleft palate) **Genetic** Birth Order (younger siblings more at risk) ENVIRONMENTAL - exposure to **tobacco smoke** - **Exposure to ppl with URTI's** eg large groups at chidcare - **Not breast fed** for six months increases risk - **Pacifiers and dummies** increase risk

Answer 20

Swollen adenoids. Can try intranasal steroid spray to reduce size of adenoids, saline spray to reduce mucus Will need referral to ENT if no improvement

ENT2 Flashcards

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