CM- ENT-5- Foreign bodies, cerumen, otitis externa
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| What s/sx might indicate a foreign body in the ear | irritable pediatric patient that is pulling at their ear
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| Why should irrigation be avoided if you don't know what is in the ear | if it is organic it could swell, a battery could leak acid or an insect could get agitated and cause problems
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| What can be used if the foreign body in the ear is an insect | used lidocaine or mineral oils to kill or paralyze the insect allowing it to be removed easier. You can also use the light method to try and get the insect out
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| When should you probably consider referral for a foreign body | if you suspect perforation of the tympanic membrane or possibility that the foreign body has entered the middle ear space refer to ENT
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| What cc might a pt have if they have cerumen impaction | decreased auditory acuity, ear feels full, discharge from ear, otalgia many will have no complaint and you will find it incidentely
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| What should you do to get cerumen impaction out of the ear | use wax disolving drops and then a currete or lavage to get the loosened plug out
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| When should you not perform lavage to get impacted cerumen out of the ear | combative child or pt, suspected perforated TM, Hx of tympanoplasty or tubes, Hx or rxns or contraindicated to water under pressure in the ear canal
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| If lavage is contra indicated what can you do to get the plug out | curette or Rx wax disolving drops (debrox or cerumenex) have pt use for several days and then return for followup
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| What is the typical clinical presentation of otitis externa | otalgia, pruritis, and foul smelling discharge (otorrhea) from the ear canal. Canal can become obstructed from edema and tender when ear is pulled on
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| If you can't see the tympanic membrane what should you do | treat then have pt return to clinic in 1 week to re-evaluate
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| What are the most common causes of otitis externa | pseudomonas aeruginosa, proteus species, staph aureus is also common
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| If you find that the cause of the otitis externa is furunculosis what would you expect to see and what is the tx | you should see acute localized otitis externa and you should treat with heat, systemic antibiotics and drainage of the abscess
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| IF you note hyphae on the exam of otitis externa what should be your tx | topical acidifying drops and topical antifungals such as gentian violet, cortcane B etc
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| If the cause of the otitis externa is herpes what is the tx | topical and systemic acyclovir
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| what is the tx for otitis externa if the cause is eczematous dermatitis | treat secondary bacterial infection then derm condition
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| What tx is helpful to prevent otitis externa | slightly acidifying drops of isopropyl alcohol and white distilled viniger in a 50:50 mixture applied after water exposure and help prevent swimmers ear and recurrent otitis externa
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