713: Wk 2 Otitis Media & Externa
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| OM clinical findings | Pain, otalgia, fever, irritability, URI signs & symptoms, night awakenings
🗑
|
||||
| OM physical exam | Full/ bulging tympanic membrane, decreased or absent mobility on insufflation, opaque tympanic membrane, otorrhea, (erythema of TM is not diagnostic)
🗑
|
||||
| Laboratory Findings of OM | Tympanocentesis of fluid id of causative organisms indicated 1) fail abx tx , suspected or confirmed complication, OM in neonate, sick neonate, immulogically compromised pt,
🗑
|
||||
| Causative organisms | Strep pneumonia (40-50%), H flu (40%), Moraxella catarrhalis, ALSO Group A Beta hemolytic strep, Staph aureus, anerobic bacteria, viruses
🗑
|
||||
| Reason for reduction in incidence o fOM | HIB vaccine, & prevnair (pneumococcal) vaccine
🗑
|
||||
| RX for OM | Antibiotic therapy
Amoxicillin 80-90mg/kg/day
Augmentin 40mg/kg/day
Cephlasporins
Ceftin
Omnicef
Cefzil
Zithromax
Biaxcin
🗑
|
||||
| Management of OM | not improved in 48-72 hours reevaluate, if no other pathology found, cover Beta Lactamase organism (augmentin)
Supportive: antipyretics and analgesics Auralgan and Otocain topical pain meeds reevaluated after 3-4 weeks with an acute otitis media
🗑
|
||||
| OM with effusion/ serous otitius | Defined as a chronic bacterial infection persisting more than 2 weeks
Terms used synonymously
Secretory otitis
Serous otitis
Chronic purulent otitis
🗑
|
||||
| OM with effusion | Clinical findings
Usually asymptomatic
Physical findings
Opaque TM
Translucent with bluish effusion
Retracted TM with decreased mobility
Air fluid levels or bubbles
Laboratory
Hearing loss is frequently present
Tapanogram – flat
Mostly tempory
🗑
|
||||
| Causative organisms of OM with effusion | Thirty-Fifty percent of effusions will grow bacterial pathogens (generally don’t cx)
H. influenza
B. catarrahalis
S. pneumoniae
S. epidermidis
🗑
|
||||
| Management of OM with effusion | Majority will clear spontaneously within 2 months
Treatment if complications associated with chronic middle ear effusions- if kid already has hearing speech delay
Investigate underlying etiology
Sinusitis
Allergy
Immune deficiency
Submucus cleft pa
🗑
|
||||
| Management of OM with effusion | -watch & wait: reexamine 3 mth, refer at 6. Nonsurgical- abx = acute OM. Surgical: myringotomy with aspiration of fluid, PE tubes.
🗑
|
||||
| Definition of Recurrent Acute Otitis Media | Distinct acute episodes interspaced by periods of complete resolution- these are kids that need PE tubes
🗑
|
||||
| Risks for Recurrent AOM (7) | First episode at age less than 6 months
Siblings in home
Patient is male
Formula fed
Day care attendance
Cigarette smoke in home
Cold weather months of the year
🗑
|
||||
| Rx for recurrent AOM | Antibiotic prophylaxis
Single daily dose
3 weeks-3 months
Minimizing risk factors
Immunizations status
Prevnar
Myringotomy/Tympanostomy Tubes
Adenoidectomy
🗑
|
||||
| When to refer recurrent AOM | Referral means surgery
4-5 episodes of acute OM in a season
Refractory disease
Mastoiditis
Speech/language delay
Hearing loss
🗑
|
||||
| Otitis Exerna | Swimmer’s ear. Etiology: common in summer
Water causes breakdown of protective lining, bacteria multiply Acute= localized. Chronic = Secondary infection from tympanic cavity discharge, multiple pathogens
Malignant = Occurs in immunocompromised patients
🗑
|
||||
| Clinical manifestations of Otitis Externa | >2 years of age
Swelling of ear canal
Erythema and purulent exudate
Mild to severe otalgia, especially with movement of the pinna
Can be associated with concomitant acute otitis media, hearing loss, ear fullness, pressure, pruritis, and severe deep pa
🗑
|
||||
| Causative pathogens of ostitis externa | Pseudomonas aeruginosa (60%)
Staph aureus (10%)
Other pathogens (30%)
Group A strep
Enterobacteriaceae
Proteus
🗑
|
||||
| Management & tx of otitis externa | Topical antibiotics
Cortisporin suspension
Fluoroquinolones
Ciprofloxacin
Ofloxacin
Fluoroquinolones with steroids
Ciprodex
OtoWick
Analgesics
🗑
|
||||
| Management of OE | Solutions of half alcohol and vinegar instilled into ear after swimming
Molded ear plugs
Particularly for PE tubes
Referral
Draining ear that persists for greater than 2 weeks with treatment
🗑
|
||||
| Cholesteotoma | Cholesteotoma: Destructive and expanding keratinizing squamous epithelium in the middle ear and/or mastoid process
Untreated can eat into the malleus, incus and stapes, which can result in nerve deterioration, deafness, imbalance and vertigo
🗑
|
||||
| Complications of OM & OE | Cholesteotoma, hearing loss, speech delay, mastoiditis, perforation, meningitis
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
JennRN
Popular Clinical Skills sets