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Ear - Clinical Medicine IV > Otitis > Flashcards

Otitis Flashcards

(87 cards)

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1
Q

Who gets acute otitis media?

A

children - due to horizontal Eustachian tube

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2
Q

Where is the fluid build up in acute otitis media?

A

behind tympanic membrane

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3
Q

What are the symptoms in acute otitis media?

A

pull on ear, painful, fever, hearing impairment (due to vibratory bones), fullness/ear pressure

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4
Q

How can you diagnosis acute otitis media?

A

otoscopic examination

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5
Q

What will you see with acute otitis media on otoscope exam?

A

bulging and lack of mobility with pneumotoscopy, possibly red

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6
Q

How do you treat acute otitis media?

A

amoxicillin - first line

or: TMP-SMX, cephalosporin or azithromycin

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7
Q

What do you for resistant acute otitis media?

A

augmentin - amoxicillin+clavulanate

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8
Q

What occurs usually before acute otitis media?

A

URI than blocks tube then fluid builds up then bacteria infects

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9
Q

What is otitis media?

A

middle ear infection

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10
Q

What are the most common pathogens in AOM?

A

s. pneumonia, H.flu, Group A strep, m. cat

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11
Q

What presentation of AOM is emergent?

A

frank swelling over mastoid bone or cranial neuropathies or central findings

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12
Q

What is the surgical drainage of the middle ear called?

A

myringotomy

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13
Q

What can develop from untreated otitis media?

A

mastoiditis, requires CT, tx myringotomy + IV ABX

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14
Q

What is chronic otitis media?

A

chronic otorrhea with perforated tympanic membrane

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15
Q

What bacteria cause chronic otitis media?

A

p. aeru, s. aureus, proteus, anaerobes

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16
Q

Is chronic otitis media painful?

A

usually not

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17
Q

How you diagnosis chronic otitis media?

A

look in ear - see drainage and rupture; hearing loss

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18
Q

How do you treat chronic otitis media?

A

remove debris, use earplugs, avoid water, topical ABX drops, ABX

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19
Q

What is the oral ABX used to treat chronic otitis media?

A

ciprofloxacin 500 mg bid 1-6 wks

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20
Q

What are the topical ABX drops?

A

ofoxacin, ciprofloxacin w/dexamethasone

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21
Q

What is a surgical tx for chronic otitis media?

A

tympanic membrane reconstruction with temporalis muscle fascia

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22
Q

What is otitis externa usually called?

A

swimmers ear

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23
Q

What is malignant external otitis ?

A

osteomylitis of skull base that requires hospitalization

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24
Q

Who gets malignant external otitis?

A

DM or Immunocompromised

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25
What causes external otitis?
gram - (pseudo, proteus) or fungi (ASPERGILLUS)
26
What causes malignant external otitis?
usually pseudomonas aeru
27
What are the symptoms of external otitis?
ear pain (tragus), redness and swelling, purulent discharge,
28
How does malignant external otitis present?
focal aural discharge, granulations in ear, deep otalgia, cranial nerve palsy
29
How do you dx malignant external otitis?
osseous erosions on CT
30
How do you treat external otitis?
swimmers ear - isopropyl alcohol + white vinegar Infected - neomycin sulfate, polymyxin B sulfate, hydrocortisone Recalcitrant - oral fluroquinolone (cipro)
31
How do you treat malignant external otitis?
ciprofloxacin for months even if asymptomatic
32
What is cholesteatoma?
white debris in chronic OM, get head CT!
33
What is the most common form of OE?
acute diffuse, swimmers
34
What OE is associated with hair follicle?
acute localized OE (furunculosis)
35
What is the duration for chronic OE?
> 6 wks
36
What OE encompasses various derm conditions that may infect the EAC?
eczematous (eczematoid) OE
37
What is OE that extends into the deeper tissues adjacent to EAC?
Necrotizing (malignant) OE
38
Who gets malignant OE?
immunocompromised - DM, HIV
39
What are the symptoms of acute infective OE?
otorrhea (foul), pruritis, hearing loss, pressure or fullness, swelling of ear canal
40
What is the most common causative agent in acute infective OE?
pseudomonas!!! | staphylococcus, anaerobes, gram -
41
What is the guidelines for OE dx and treatment?
1. rule out other causes 2. assess factors that could modify management 3. assess for pain
42
What type of ABX do you get for OE?
TOPICAL
43
What can cause acute OE?
obstruction, lack of cerumen, trauma, alteration of pH by removing wax
44
What happens once infection is established in OE?
skin edema, exudate and drainage
45
What are the treatment of otitis externa?
pain management, remove debris, administer topical meds. avoid contributing factors
46
What are the topical ABX used for OE?
ABX + sertoid combo avoid alcohol Ciprodex or Ofloxacin, 4 gtt in affected ear BID x 5-7 days
47
What do you do in OE if canal is swollen?
otowick -> keps ear dry
48
What are the bacterial OE treatment options?
ciprofloxacin Cirpo+hydrocoritsone - cipro HC Cipro/dexameth - ciprodex Neomycin/polymyxin B/hydrocortison - cortisporin Ofloxacin Hydrocortisone/acetic acid - bacterial or fungal
49
What is the clinical manifestation of malignant OE?
persistent otalgia >1 mo, purulent otorrhea, granulation tissue or exposed bone in ear canal, CN involvement VII, X, XI
50
What is the treatment for malignant OE?
inpatient admission, CT scan temporal bone, culture ear, IV ABX, surgical debridement
51
What are the IV ABX for malignant OE?
ciprofloxacin, aminoglycosides, 3rd generation cephalosporin, imipenem, ticarcillin/clavulante
52
What is great about ciprodex and ofloxacin?
safe to give if TM rupture
53
What are some of the causes of eczematous OE?
atopic dermatitis, psoriasis, SLE. eczema
54
How do ezcematous OE present?
super itchy ear
55
What would you see in ezcematous OE ear canal?
skin sheets, keratin debris
56
How do you treat ezcematous OE?
steroid - fluocinolone optic (dermotic) oil apply 5 gtt in ear BID x 7-14 days, may need chronic tx
57
What is herpes zoster oticus?
ramsy hunt - shingles of the ear
58
How does the pt with herpes zoster oticus present?
burning pain, eruption of vesivular rash, not always visible, hearing loss, facial nerve paresis
59
What is the treatment for HZO?
Acyclovir 800mg PO 5 times per day for 7 days Famciclovir 500mg PO 3 times per day for 7 days Valcyclovir 1000mg PO 3 times per day for 7 days Steroids - prednisone or medrol dose pack
60
What is acute suppurative OM?
inflammation of middle ear and TM, infective cause
61
What is serous non-suppurative OM?
residual effusion post infection or related to ETD
62
What is the time line for non-suppurative OM?
acute 3 mo
63
What is the chronic types of OM?
infection in middle ear w/ TM perforation | w or w/o cholesteatoma
64
What is the dx of serous OM?
air fluid levels behind TM, type B tympanometry, conductive hearing loss
65
What is the treatment for serous otitis media?
``` systemic ABX - Amoxicillin Decongestants Oral steroid - prednisone antihistamines myringotomy ```
66
What is the presentation of acute OM?
after URI, otalgia w/ systemic symptoms | Fever, N/V/D
67
Who is acute OM common in?
3 mo to 3 yrs
68
What causes acute OM in newborns?
s. pneumo, H. flu, Gram - enteric bacilli (e coli, klebsiella, pseudomonas)
69
What causes older infant and children
strep pneumo, m. cat, h. flu, less common group A strep and s. aureus
70
What causes pt > 14 yo to get acute OM?
s pneumo, s. aureus, group A
71
How do you dx acute OM?
TM bulging and ear pain for less than 48 hr, intense erythema,
72
When should AOM not be dx?
pneumatic otoscopy and tympanometry do not show middle ear effusion
73
Who gets ab for AOM?
severe signs = temp >39 C rectally within 24 hr, moderate to severe otalgia present for >48 hr
74
What age always gets ABX for AOM?
75
What do you need if 6mo-2 yr for ABX for AOM?
observe only for 48-72 if not severe | tx if bilateral OM
76
What do you do for >2 yr with AOM?
ABX if severe, observe for 72 hr if not
77
What are the disqualifiers for using amoxicillin in kids with AOM?
had it within 30 days, has concurrent conjunctivitis, allergic to penicillin if cant then take Amoxicillin-clavulante, cefuroxime, azithromycin, TMP-SMZ
78
What can cause chronic OM?
AOM, ETD, mechanical trauma, thermal or chemical burns, blast injuries, iatrogenic cause
79
What is chronic OM associated with increased risk?
craniofacial abnormalities, down syndrome, cri du chat syndrome, cleft lip, choanal atresia, microcephaly
80
What are complications from COM?
aural polyps, cholesteatoma, other infections
81
What are the most common causative agents of COM?
p aeru, proteus, s. aureus, mixed anarobes
82
How do you dx COM?
culture drainage, CT or MRI for intratemporal or intracranial process
83
What is a type of COM thats super serious?
cholesteatoma
84
What is cholesteatoma releated to?
prolonged ETD and retraction of TM
85
What is treatment for cholesteatoma?
surgical removal
86
What is the treatment for COM?
keep ear dry, clean ear, topical steroids and ABX, systemic ABX, surgery
87
What are the surgeries for COM?
tympanoplasty - marginal or attic perforations

Ear - Clinical Medicine IV (15 decks)

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