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acute otitis media (1)

Terms in this set (51)

AOM etiology
strep pneumoniae
haemophilus influenzae
morazella catarrhalis
strep pyogenes
viral
AOM patholgy
commonly there is a preceding URI resulting in congestion & obstruction of middle ear and eustachian tubes
prime medium for bacterial growth
AOM epidemiology
first peak at 6-15 months
second peak at entry of school
90% children experienced inf. by age 2
pacifier use
smoking
bottles in bed
AOM clinical manifestations
otalgia
fever
hearing loss
otorrhea
tinnitus
vertigo
AOM signs
red inflamed TM
decreased mobility with pneumatic otoscopy
conductive hearing loss
tympanometry
diagnosis of OM
acute s/sxs
middle ear effusion
limited mobility of tympanic membrane
air fluid level
treatment
wait and see rx
antimicrobials
analgesics
antipyretics
antimicrobial treatment for acutely ill child with fever, otalgia, and severe illness
amoxicillin 80 mg/kg per day
antimicrobials for recurrent OM
amoxicillin-clavulanate
90 mg/kg per day of amoxicillin
6.4 mg/kg per day of clavulanate
AOM antimicrobials for PCN allergic use
cefdinir
cefuroxime
cefpodoxime
azithromycin
clarithromycin
AOM antimicrobials for severe illness and PCN allergy
cefriaxone 1 or 3 days
AOM duration of antimicrobial treatment
10 days
shorter course of 5-7 in children 6 yo. and up in mild/moderate disease
AOM analgesic treatment
ibuprofen
acetaminophen
auralgan
AOM antipyretic treatment
ibuprofen
acetaminophen
AOM complications
hearing impairment
vestibular impairment
chronic effusion--> myringotomy and tympanostomy tubes
perforation of TM
mastoiditis
cholesteatoma
meningitis
AOM prevention
education
influenza and pneumococcal vacines
chemoprophylaxis
surgery
chemoprophylaxis
continous AB use
amox or sulfa once a day dose
used in recurrent OM of 3> in 6 month period
AOM surgery
tympanostomy tubes
adenoidectomy/tonsillectomy
otitis externa (OE)
aka swimmer's ear
inflammation of external auditory canal or auricle
associated with inf., allergies, dermal disease
OE etiology
most common form due to bacterial colonization of canal
pseudomas aeruginosa
staph aureus
peptostreptococcus
bacteroides
fungal
OE defense mechanisms of ear canal
tragus and conchal cartilage cover opening as barrier against FB entrance
hair follicles and narrowing of isthmus for protection
cerumen bc hydrophobic, acidic, sticky
OE epidemiology
swimming
excessive cleaning/itching of canal
devices that occlude ear canal
OE clinical manifestations
otalgia
pruritus
discharge
hearing loss
OE signs
pain with manipulation of tragus
canal is edematous, erythematic with yellow, brown, white, grey debris
OE treatment
remove debris
analgesia
culture severe/recurrent cases
educate
cautious with otomycosis
OE ototopical agents for inf/inflammation
should be acidic, have steroid, antiseptic, and antibiotic
cipro HC
ciprodex
cortisporin otic
tobradex
pred-g
OE severe presentations require what?
PO or IV antibiotics
augmentin
cephalexin
dicloxacillin
fluroquinolone
malignant OE
older/immunocompromised
pseudomonas
begins at junction of cartilage and bone in external auditory canal
granulation tissue on osseous canal
inf. in temporal bone along santorini fissure and into mastoid
where does malignant OE start
external auditory meatus and may progress to parotid region, mastoid, middle ear, and skull base
treatment of malignant OE
ceftriaxone
amoxicillin-clavulanate
may require surgical debridement
normal hearing includes
responses of air and bone conduction
movement of organ of Corti
inner hair cells
auditory nerve
brain
sensorineural hearing loss (SNHL)
related to pathology of inner ear, cochlea, or auditory nerve
conductive hearing loss
obstructive in nature such as cerumen impaction, middle ear fluid, ossicular distortion, infection
hearing loss exam
historical evaluation
physical exam (pneumoscopy)
hearing evaluation
historical evaluation of hearing loss
R/O hereditary causes
trauma
infection
previous ear c/c
association with other neuro findings
hearing evaluation
whispered voice
256 (10-15 dB) and 512 (20-30 dB) tuning fork hearing
weber and rinne tests
hearing loss diagnostic testing
formal audiological evaluation
tympanogram
brainstem auditory evoked response
CT/MRI of inner eat
what does brainstem auditory evoked response measure?
response to sound to point to the site of SNHL
sensorineural hearing loss
congenital
presbycusis
noise exposure
barotrauma
meniere's
presbycusis
6th decade of life
multifactorial causes
age related changes of 8th cranial nerve
begins as general loss of clarity
increases in noisy areas
treatment for idiopathic sudden sensorineural hearing loss
oral corticosteroids tapered over 10-14 days
addition of zinc to increase recovery
factors that influence Meniere's disease
genetics
viral etiology
hypoplasia of vestibular aqueduct
degeneration findings
vascular distortion with assoc. of migraines
etiology unknown
definitive diagnosis for meniere's disease
made postmortem by histopathological evaluation of temporal bone for endolymphatic hydrops
menieres clincal manifestation
episodic vertigo
SNHL
aural fullness
tinnitus
menieres description
rare idiopathic disorder of inner ear
recurrent, spontaneous attacks of vertigo, tinnitus, fluctuating hearing impairment, aural fullness
how to diagnose menieres disease
exclude other causes based on neurological and audiological evaluation
MRI
must have two episodes of rotational vertigo lasting 20 min, SNHL, tinnitus and aural fullness
miniers treatment
supportive bc no cure
restrict salt and caffeine
no smoking
diuretics
antiemetics (meclizine 25mg TID prn)
intratympanic gentamycin
vestibular neuronitis
aka vestibular labyrinthitis
inflammation of vestibular portion of 8th CN
associated with viral inf.
vestibular neuronitis s/sxs
vertigo
nausea
possible hearing loss
last up to a week
vestibular neuronitis
meclizine
acoustic neuroma
aka acoustic schwannoma
benign tumor of 8th CN
asymmetrical loss of hearing
assoc. with disequilibrium and tinnitus on affected side
dx via MRI
refer to ENT
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