Lecture 3 - Otic Disorders Flashcards by Patryk Lasiuk

predisposing factors to impact earwax?

narrow/deformed ear canals
Overactive glands
using hearing aids or earplugs
excessive hair growth in eternal auditory canal
age = drier
Male> females

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signs and symptoms of impacted earwax

feeling of fullness, pain or itching in ear canal
ringing in ears
loss of hearing ~80% obstruction

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How to prevent impacted earwax

clean outer ear regularly
clear ear devices regularly
irrigation + prophylactic cerumenolytic agents

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Self-care exclusions for Otic disorders

signs of infection
Pain w/ ear discharge
bleeding or trauma
ruptured tympanic membrane
ear surgery w/I 6wks
Tympanostomy tubes
< 12 yrs old

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Treatment for impacted earwax

Cerumenolytics
irrigation
manual removal

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water-based cerumenolytics

Acetic acid 2.5%
Docusate sodium 10mg/ml
Hydrogen peroxide 3%
Sodium bicarb 10%
Sterile water or saline

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Carbide peroxide admin

5-10 drops, let sit for 15min, flush w/ water water and make sure all drained

repeat 2X day for 4 days

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Carbide peroxide ADE

Popping sounds on admin

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Carbide peroxide counseling points

careful to not break tympanic membrane

if dizziness occur, contact HCP

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Ear drop admin adults

wash hands
lie on side so affected ear facing up
pull auricle up and toward back of head, instill drops

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Ear drop admin kids < 3

wash hands
lie on side so affected ear facing up
gently pull earlobe down toward the back of the head, instill drops

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earwax removal

irrigation or manual removal (by trained professional)

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what to avoid for earwax removal

using cotton swabs or ear candling

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predisposing factors to water-clogged ears

shape of ear canal
excessive earwax
swimming
excessive sweating
humid climates

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signs and symptoms of water-clogged ears

feeling of wetness or fullness in ear
gradual hearing loss
not usually painful

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non-pharm treatment for water-clogged ears

tilt head to side
lie down w/ affected ear facing down
chew/yawn

hair dryer on low setting

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swim-EAR

isopropyl alcohol 95% in anhydrous Glycerin 5%

safe/effective

use after shower, swim, bath, washing hair

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swim-EAR MOA

alcohol mixes w/ water and help dry canal, >70% can act as disinfectant

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swim-EAR ADE

Generally well tolerated

can cause stinging if skin is broken

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swim-EAR admin

instill 4-5drops into open ear canal
let sit for 30sec-1min
tilt head to side and let it drain out

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Risk factors to swimmers ear

High humidity
warmer temp
maceration of skin
local trauma to external ear
exposure to water that is high in bacteria

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signs and symptoms of swimmers ear

rapid onset
severe ear pain
itching
fullness

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prevention of swimmers ear

using ear plugs
dry ear after swimming
tilt head to remove water

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swimmers ear usually treated with….

topical antimicrobials, 7-10 day treatment

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If ruptured tympanic membrane, you want to use...

Fluoroqinolones

what should be avoided for ruptured tympanic membrane

Cipro-HC avoid aminoglycosides

topical antimicrobail fluoroquinolones

cipro 0.2/0.3% cipro 0.3%/dex 0.1% Cipro 0.2%/hydrocort 0.1% = no use rupture Ofloxacin 0.3%

swimmers ear non-pharm treatment

minimuze trauma to/manipulation f ear avoid water submersion for 1 week use ear plug when shower dry canal after showering

Analgesics preferred for swimmers ear?

Oral preferred, scheduled instead of PRN....48-72hrs worth

are oral antibiotics used for swimmers ear?

not really, dont need to use

who can recieve oral antibiotics for swimmers ear?

Altered immune function prior radiation Tympanostomy tubes or perforated TM

acute otitis media is...

ear infection

risk factor for ear infection

day care siblings in home lack of breast feeding exposure to tobacco smoke lower socioeconomic status use of pacifier anatomic abnormalities

most common causes ear infection

viruses Strep. pneum H.influ M.ctarrhalis

diagnosis of ear infection

rapid onset of pain presence of middle ear effusion (MEE)

severe ear infection

Moderare or sever pain for > 48hrs or temp >39 or 102

non-severe ear infection

mild pin for < 48hrs and temp < 39C or 102

6-23 months, non-severe unilateral

observe or 10 days ABX

2-5yrs, non-severe bilateral or unilateral

observe or 7 days ABX

>6yrs, non-severe bilateral or unilateral

Observe or 5-7days ABX

1st line therapy for initial immediate or delayed therapy Ear infection

High dose Amox = 80-90mg/kg/day BID or Amox/clav = 90mg/kg/day amox + 6.4mg/kg/day clav BID

alternative medications for ear infection if PCN allergy

Cefdinir Cefuroxime Cefpodoxime Ceftriaxone

1st line if antibiotic treatment failed for ear infection

Amox/clav = 90/6.4 mg/kd/day BID or Ceftriaxone 50mg/kg/day IM/IV 3 days

alternative if failed 2nd ABX for ear infection

Clindamycin 30-40mg/kg/day PO TID w/ or w/o 3rd gen cephalosporin

why use watchful waiting

normal clinical course of AOM= can resolve alone ADEs associated w/ ABX Proper use of analgesics Followup plan if sx done improve

prevention of AOM

immunizations - Prevnar, pneumovax, flu breastfeeding = least 6 months avoid tobacco smoke

Most common cause acute bacterial rhino sinusitis (ABRS)

strep pneumo H. influ M.catrrhalis

symptoms of sinusitis

Key = discolored discharge sinus pressure/pain post-nasal drip sore throat toothache cough headache fatigue

Diagnosis of ABRS

> 10 days symptoms Fever >39 + discharge/pain worsening = new onset of fever/HA, inc nasal drainage

ABRS 1st line children

Amox/clav 45mg/kg/day BID 10-14 days

ABRS 2nd line children

Amox/clav 90mg/kg/day BID 10-14days

ABRS B-Lactam allergy Type 1 children

levo 10-20mg/kg/day q12-24hrs

ABRS B-lactam alelrgy Non-type 1 children

Clindamyxin 30-40mg/kg/day TID + cefixime or cefpodoxime

Severe infection req hospital ABRS children

IV Ceftriaxone or ampicillin/sulbactam 2nd = Cefotaxime or Levoflox IV

ABRS 1st line adult

Amox/clav 500/125 TID or 875/125 BID 5-7days

ABRS 1st line adult B-lactam allergy

Doxy 100mg PO BID 5-7days

ABRS 1st line adult severe infection req hospital

Ceftriaxone 1-2g IV q12/24hrs Ampicillin/sulbactam 1.5-3g IV q6h

ABRS 2nd line adult

amoxicillin/clav 2000/125 PO BID Doxy 100mg PO BID

ABRS 2nd line adult B-lactam allergy

Levo 500mg PO QD Moxiflox 400 PO QD

ABRS 2nd line severe infection

Levo 500 PO or IV QD Moxiflox 400 PO or IV QD

Who gets High dose Amox/Clav for ABRS

high endemic rates >10% of pen non-sus S.pneum Severe infection ( systemic toxicity, > 39C) attend daycare Age < 2 or > 65 Recent hospitalization w/I 5 days ABX use in last month immunocompromised or comorbid conditions