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Peds Ears

713: Wk 2 Otitis Media & Externa

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
Created by: JennRN
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