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Label the anatomy of the ear

Tympanic membrane, ossicles (malleus, incus, stapes)

List the etiologies of otitis media, including bacterial + viral sources.

1) otitis media (<2 yo...S.pneumoniae (most common)), H. influenza, M. catarrhalis. 2) Otitis media (>2 yo) - usually viral

Risk Factors and infectious causes of otitis media in adult and kids?

MO.SAP.HEADS: Medications (esp for adults), occupation (not wearing ear plugs), sinus, age <6, hearing loss/concern, ETD, allergies, daycare/bottle feed, smoker

What are the S+S of otitis media?

appetite (decreased), ear popping, irritable, otalgia, fever, fullness, vertigo, hearing loss

How do you diagnose otitis media?

With tympanometry (gold standard) --> pneumatic otoscope. The TM will have decreased movement, it's bulging, erythmatous, cloudy/opaque TM.

Potential complication of otitis media

Retracted part of the pars flaccida of the tympanic membrane (meningitis, mastoiditis, perforated tympanic membrane (let heal on its own), and cholesteatoma (very rare, almost never occurs, benign, grows out of the mastoid and middle ear)

Potential complication of otitis media

2) Early nasopharnygeal carcinoma (well known for its silent nature, usually its only sign is unilateral OME (otitis media w/effusion) Later the tumor metastasizes to the cervical lymph nodes and extends into the skull base, causing cranial neuropathies. (like COM - mastoiditis)

Potential complication of otitis media

3) Cholesteatoma (surgical removal) = accumulation of desquamated keratin epithelium, tumor-like mass may involve mastoid + surrounding area, slowly erodes bone, may cause facial paralysis, conductive hearing loss. Etiology: complication of chronic OM or untreated perforated TM. Studies: CT or MIR to r/o brain or mastoid involvement. Tx: surgical removal

What's the treatment for acute otitis?

1) Amoxicillin (kids and adults) (if a PCN allergy - azithromycin) (TMP -SMX, amoxicillin-clavulonic acid, 2nd gen cephalosporins) 3) tympanocentesis may be appropriate. Any child <2 must be treated with antibiotics. Over 2 yo? need a larger clinical picture!

What's the treatment for chronic otitis?

1) Pressure equalization (PE) tube insertion. Sm tubes are placed in the TM to "vent" the middle ear + prevent negative pressure buildup. The tube isn't intended to drain fluid, but for pressure equalization. Kids often grow out of ET dysfxn and tubes fall out at 1-2 yo. 2) myringotomy tubes - tiny incision is made into the ear dru,m, and usually once the otitis resolves, so does the hole. do it with adenoidectomy if they've had hearing loss for >3 mo. after 2 weeks on an antibiotic!

When do you refer to a specialist?

3 infections within 6 months. 4 infections within a year.

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