Terms in this set (95)
-the inflammation,irritation, or infection of the external ear canal, and is sometimes called swimmer's ears.
S/S edema, drainage, pain with pull on pinna
An infection of the middle ear caused by bacteria. Children are more susceptible because their auditory tubes are shorter
Acute suppurative mastoiditis usually evolves following several weeks of inadequately treated acute otitis media. It is characterized by postauricular pain and erythema accompanied by a spiking fever.
Ear: Inflammation of the Labyrinthine canal of the Inner Ear occurs as a complication of an acute Upper Respiratory VIRAL or BACTERIAL infection; Sever Vertigo; Nystagmus
If acute otitis media is left untreated, it may lead to the condition known as ______.
55 yo F c/o dizziness that started this morning and of "not heading well." She feels nauseated and has vomited once in the past day. She had a URI 2 days ago.
protective against bacteria
Common bugs in otitis externa
S. Aureus and Psuedomonas Aeruginosa (will not green purulence)
Who gets malignant otitis externa
Older pts, immunocompromised
Often progresses to school-Osteomyelitis
Tx drops? considerations?
Fluoroquinolone (Ciprofloxacin drops)
If symptoms are localized, treat locally; if systemic, treat systemically
Culture drainage if possible
Oral abx will not work alone! Must also use topical.
Keep ear dry during treatment.
Follow up in one week to be sure improved, resolved, see TM
After resolved, prophylactic for swimming?
use 1:1 white vinegar and rubbing alcohol before and after swimming-
Since you will not likely see the TM,
make sure you use a nontoxic drop that will not harm the inner ear
May use EYE drops in the ear, but may not use EAR drops in the eye!
May need to use a wick (sponge) to drip meds into EAC
S/S Acute otitis media
sudden onset, fever, ear pain, appetite change, TM red/effusion with poor mobility and a bulge/rupture,
Look for drainag from tubes
Use in pediatric pts to assess the mobility of the tympanic membrane
The use of air pressure in the ear canal to test for disorders of the middle ear
Obstructed eustachian tubes can lead to ____
chronic supparative OM
A conditoin lasting > 3 months (could last +20 years!) characterized as a permanent TM perforation or cholesteatoma.
Otitis media effusion?
Describes the non-acute presence of a middle ear effusion without signs or symptoms of infection
poor responce to insufflation
- efx on hearing if present longterm
Who gets OM
Kids with eust. tube dysfunction: nasal fluids pulled into ear, fluid is agar for bacteria and ET are often more horizontal, shorter and wider in infants.
OM and breast vs bottle?
Breast increases antibodies
Propping with bottles, leads to increased opportunity for bacterial aspiration
Bacteria usually come from daycare. Viruses do what to ET function?
impair function via adenoid swelling and ET inflammatoin
Do viral illnesses lead to bacterial OM?
Yes, RSV/Influenza usually 3-14 days later.
Seasonal surge from January to May
I never look into ears I just give 90mg/kg/day Amoxicillin BID and go to lunch.
70%? Anatomy and bacterial logistics!
Red TM has to be OM!
Wrong, Red TM 2ndary to crying fever possible
No Q-tips even though it feels so good!
Inpacted cerumen is blocking visualization
Also known as earwax, is secreted by ceruminous glands that line the auditory canal. This sticky yellow-brown substance has protective functions because it traps small insects, dust, debris, and certain bacteria to prevent them from entering the middle ear.
Cleaning out the cerumen? Options?
Water pick lavage, curette
Caution fluids if pt has tubes or perforation.
Mineral oil/olive oil 2xweek to minimize impaction
tympanometry? what's it good for?
Diffentiates between OM and SOM, as well as ET tube disfunction. cool.
a chalky, white irregular patch on the tympanic membrane, which is a deposition of hyaline material within the layers of the TM that sometimes follows a severe episode of otitis media;
TM retracted so laying on mid ear bones, caused by negative pressure in mid ear space, affects 5-16 year olds, conductive HL
acute otitis media, cholesteatoma, trauma, epidermoid, CHARGE syndrome, avascular necrosis
A cyst filled with keratin that grows within ME.Result of chronic otitis media, Growth may be infectious.May restrict movement of ossicles.
Congenital & aquired
Tx OM pain
Tylenol, Ibu, topical drops sans rupture
Watch and wait vs abx?
If severe or pt is under 6 months always abx
often overtreated = abx resistant
over 2 and non-severe? 47-72 hrs
Amoxicillin first line
90mg/kg/day divided BID
Augmentin ES gives higher dose of amoxicillin without doubling the clavulanate;
next step if child is not improving after 48-72 hours on amoxicillin
If still not improving? 4th line?
Check parental compliance &
IM Rocephin vs. ENT referral for tympanoplasty
Surgical repair (of the hearing mechanism) of the middle ear (including the tympanic membrane and the ossicles)
Only for recurrent OM
Used often while awaiting PE tubes or in the spring
Not for effusion (fluid)
Encourage breast feeding
Reduce pacifier use
Day care alternatives
Other prevention? 3
Tubes, allergy testing and vaccines
spread from middle ear
60% under 2, many without AOM hx
Post auricular pain, ear protrusion and fever
M is swollen, red and tender
S. pneumoniae, s. pyogenes, S. aureus and H. influenza
mastoiditis tx (4)
IV abx, surgical drainage, topical eardrops and long term abx
Perforated TM refer
but with middle ear hematoma might you watchful waiting before refferal
Pinna hematomas tx or no?
Leads to permanent changes aka cauliflower ear. ENT Refer
Unusually small size or absence of the external ear(s).
the top of the ear is folded down and forward, most common external anomoly
Low set ears
Downs, DiGeorge, Trisomy 13, 18(Edwards) or 21
tiny folds of skin just in front of the pinna area, possible representing incomplete embryological development
patients found with these ear abnormalities should be examined for other congenital anomalies
Sensory neural loss contributed to (3) congenital
50% is hereditary
Aminoglycoside induced by gentamycin
What is included in newborn hearing screen?
Auditory brainstem responce
Otoacoustic emmision testing
Office clinical exam
Startle responce to loud noise
Eye blinks, turning head toward noise
Consonant sounds in speech at 11m
failure = refer
most common pediatric infectious disease, usually rhinovirus
When do you give the honey?
after 12 months
Preceded by viral URI
Cold sxs for 10-14 days or worsening sxs after 5-7 days
Caution re: spread to surrounding structures (eye, brain)
Tx of B. Rhinitis
abx for >10ays congestion
If persistant past 21 days of tx,
Surgical interventions of B. Rhinitis
Endoscopic sinus surgery
A congenital anomaly of the anterior skull based characterized by closure of one or both nasal cavities. Since newborns are primarily nose breathers, this could cause significant respiratory distress.
Nose is very vascular
Kisselback area(anterior septum)
Picking, blowing, nasal sprays
Tx vasoline or bactroban BID
Persistent nose bleed?
Hematoma of septum leads to necrosis
Abrupt nasal obstruction after trauma
Attempt blowing, alligator forcepts
Batteries are a true emergency
Painful, Aphthous ulcers
Lips, tongue, tonsils, palate
Tx: tylenol, ibu, and magic mouthwash
HSV Gingivostomatitis looks like?
ulcers on buccal mucosa, lips, tonque and gums but typically not pharynx
HSV Gingivostomatitis symptoms/tx
No steroids, acyclovir?
Thrush: causative agent, treatment acutely and refractory
90% of sore throats a viral or bacteria?
Mononucleosis A.Viral Phyr/tonsilitis
Consider mono if spleen is palpable or posterior cerivcal nodes
Amoxicillin is contraindicated in mono (causes rash)
Persistent sore throat greater than 5 days; mono spot may not be positive early in course
Preschool and adolescence
Acute viral pharygitis and tonsilitis: Herpangina
3mm halo ulcers on anterior tonsil pillars, soft palate adn uvula
Acute viral pharygitis and tonsilitis: Coxsackie
Hand, Foot and Mouth
Vesicles, pustules, or papules on palms, soles and buttocks
Acute bact. pharygitis
Sore throat with
Positive throat culture for Group A strep
Fever greater than 101
What percent of sore throats with fever are strep?
Untx. Strep->Scarlet Fever->Rheumatic fever
Palatal petechiae, beefy red uvula, strawberry tongue, tonsillar exudate suggest strep- confirm with culture
Tx strep throat
amoxicillan 50mg/kg/day bid 10 days
IM penicillin G
If allergic Azithromycin
Why did Keith never get sick while his sister did?
Ha Ha, Carrier
Treat if family is often sick
Trismus (won't open mouth)
tx: Admit 24-48hrs, I&D?,
Infection from adenoids, nasopharynx, and sinuses
Fever, drooling, neck hyperextension, dysphagia, gurgling respirations
Prominent swelling on one side of posterior pharyngeal wall ; stops at midline
Hospitalization with IV abx
Unilateral, solitary anterior cervical node
CBC, Strep test
Cat scratch fever?
Gold standard for dx of sleep apnea?
Sleep apnea surgery?
Tonsillectomy indicated for habitual snoring with gasping, daytime sxs (consider OSA in behavioral complaints), enlarged tonsils
Tonsillectomy and Adenoidectomy
Indicated in hypertrophy
7 or more/year
______ , or sores on the sides of the mouth indicate a Riboflavin deficiency.
often babies are born with a hard, callous-like spot on the upper lip if they sucked their finger in utero
On the tongue, areas of erythema (atrophy of filiform) surrounded by raised, white border?
Dorsal surface of the tongue apperas to have deep fissures or grooves that may become irritated. Food may collect in grooves. Patients are recommended to brush with soft toothbrush. No treatment indicated.
Caused by fungal infection or other health condition, may be an overgrowth of trapped bacteria. Can be brushed off.
...Big tongue, may happen in Down syndrome, Acromegaly, and hypothyroidsm and Beckwith-Weidman Syndrome
A condition that occurs when the lingual frenulum is abnormally short or rigid causing that individual to be "tongue-tied".