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ComPbms.HEENT

Ear Complaints

QuestionAnswer
Hearing Loss Patients presenting with c/o hearing loss need a complete exam, and in the absence of obvious disease referral for Auditory testing.
Hearing Loss The most common cause of hearing loss is cerumen impaction. Other hearing loss can occur from trauma to the tympanic membrane or chronic serous otitis, otosclerosis. All three may be managed by the NP.
Hearing Loss Cerumen impactions must be removed, most simple need the instillation of a softening agent and then irrigation. Irrigation is best preformed in the office setting to avoid trauma to the TM.
Hearing Loss If otosclerosis is suspected for the cause of hearing loss the patient needs to be referred to ENT or auditory specialist. Otosclerosis is the conductive loss of hearing and most common cause of hearing loss in the young.
Otitis Media; What Otitis Media is the presence of fluid in the middle ear accompanied by the signs and symptoms of infection. Seen infrequently in adults and ear pain is often related to referral pain from the teeth, tonsils, nasopharynx , or sinuses.
Otitis Media; Physical FIndings Direct visualization of the TM reveals signs of local inflammation, erythema with diminished light reflex, poor motility of the TM. Otalagia, mild to severe, stuffy feelings, Otorrhea, vertigo.
Otitis Media; Referral Pt with persistence of effusion and or hearing loss may need referral to otolaryngologist. Patients with chronic otitis or the persistence of fluid after treatment need referral for possible myringotomy.
Otitis Media; tx Antibiotic therapy: Amoxicillin is still considered first line therapy in adults as well as children. Augmentin is second line therapy. Second generation cephlosporins. TMP/SMX . Macrolides.
Failure of tx Failure is the absence of clinical improvement after 3 full days of therapy.
Chronic Otitis Media Chronic Otitis Media is the persistence of infection after failure of antibiotics to resolve symptoms.
Otitis Externa; What Otitis externa is the inflammation of the external auditory canal, auricle, and tympanic membrane.
Otitis Externa; subgroups Subgroups: Acute localized (furunculosis). Acute diffuse bacterial (swimmer’s ear). Chronic. Eczematous. Fungal (otomycosis). Invasive or necrotizing(malignant).
Otitis Externa; Epidemiology Common disorder and the reason for 3-10% of ear c/o. Swimmers ear is seen during hot, humid weather after water is trapped in the ear canal. Necrotizing otitis externa is seen in immunocompromised, elderly and DM patient.
Otitis Externa; Physical Findings Acute localized- furuncles are found in the outer third where hair follicles are, pointing and can be superficial or deep and diffuse. Eczematous otitis is as it sounds, dry, scaling and small fissures possible.
Otitis Externa; Swimmers Ear Physical Findings Swimmers ear Begins with pressure, and fullness in the ear which becomes increasely painful and tender. Swimmers ear will have erythema, and serous secretions which may progress to purulent.
Otitis Externa; Physical Findings TM may be pale and dull. Usually there is an absence of fever and chills. Otomycosis in the primary infection itching is the main symptom, may progress to a superimposed bacterial infection.
Otitis Externa; Necrotizing or Malignant OE Physical Findings Necrotizing or malignant otitis presents with redness, swelling and tenderness. It can progress causing severe pain, otorrhea, and facial nerve palsy. These patients may have other cranial nerve involvement and should be referred.
Otitis Externa Tx I&D of pointing furunculosis, heat may assist in resolution of furuncles. Use of an ear wick to facilitate medication administration to the canal is recommended when edema is severe.
Otitis Externa Tx Appropriate topical medication based on the cause is the best method of treatment, oral antibiotics are reserved for severe cases.
Otitis Externa Tx; Abx Antibiotics are combined with topical corticosteroids which aids in pain relief. Neosporin, Cortisporin otic, polymyxin B are common first line choices. Quinolones otic solutions are a good choice and have good compliance due to BID dosing.
Otitis Externa Tx; Abx Aminoglycoside ophthalmic solutions can be used for resistant organisms. Antifungals: Amphotericin B, Clotrimazole, and Tolnaftate.
Created by: DianaB
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