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Peds Ears

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Question	Answer
OM clinical findings	Pain, otalgia, fever, irritability, URI signs & symptoms, night awakenings
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
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
RX for OM	Antibiotic therapy Amoxicillin 80-90mg/kg/day Augmentin 40mg/kg/day Cephlasporins Ceftin Omnicef Cefzil Zithromax Biaxcin
Rx for recurrent AOM	Antibiotic prophylaxis Single daily dose 3 weeks-3 months Minimizing risk factors Immunizations status Prevnar Myringotomy/Tympanostomy Tubes Adenoidectomy
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
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
Complications of OM & OE	Cholesteotoma, hearing loss, speech delay, mastoiditis, perforation, meningitis
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
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
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,
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
OM physical exam	Full/ bulging tympanic membrane, decreased or absent mobility on insufflation, opaque tympanic membrane, otorrhea, (erythema of TM is not diagnostic)
Reason for reduction in incidence o fOM	HIB vaccine, & prevnair (pneumococcal) vaccine
Causative pathogens of ostitis externa	Pseudomonas aeruginosa (60%) Staph aureus (10%) Other pathogens (30%) Group A strep Enterobacteriaceae Proteus
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
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
Management & tx of otitis externa	Topical antibiotics Cortisporin suspension Fluoroquinolones Ciprofloxacin Ofloxacin Fluoroquinolones with steroids Ciprodex OtoWick Analgesics
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
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
Causative organisms	Strep pneumonia (40-50%), H flu (40%), Moraxella catarrhalis, ALSO Group A Beta hemolytic strep, Staph aureus, anerobic bacteria, viruses
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

Management of OM	Answer: 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	2	0	false
Surgical	-watch & wait: reexamine 3 mth, refer at 6. Nonsurgical- abx = acute OM. _____: myringotomy with aspiration of fluid, PE tubes.	3	1	true
resolution	Distinct acute episodes interspaced by periods of complete _____- these are kids that need PE tubes	4	1	true
40mg/kg/day	Antibiotic therapy Amoxicillin 80-90mg/kg/day Augmentin _____ Cephlasporins Ceftin Omnicef Cefzil Zithromax Biaxcin	5	1	true
status Prevnar	Antibiotic prophylaxis Single daily dose 3 weeks-3 months Minimizing risk factors Immunizations _____ Myringotomy/Tympanostomy Tubes Adenoidectomy	6	1	true
Cholesteotoma	Answer: 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	7	0	false
generally	Thirty-Fifty percent of effusions will grow bacterial pathogens (_____ don’t cx) H. influenza B. catarrahalis S. pneumoniae S. epidermidis	10	1	true
especially	>2 years of age Swelling of ear canal Erythema and purulent exudate Mild to severe otalgia, _____ with movement of the pinna Can be associated with concomitant acute otitis media, hearing loss, ear fullness, pressure, pruritis, and severe deep pa	11	1	true
Findings	Laboratory _____ of OM	12	0	true
membrane	Full/ bulging tympanic _____, decreased or absent mobility on insufflation, opaque tympanic membrane, otorrhea, (erythema of TM is not diagnostic)	14	1	true
externa	Causative pathogens of ostitis _____	16	0	true
hearing	Majority will clear spontaneously within 2 months Treatment if complications associated with chronic middle ear effusions- if kid already has _____ speech delay Investigate underlying etiology Sinusitis Allergy Immune deficiency Submucus cleft pa	17	1	true
multiply	Swimmer’s ear. Etiology: common in summer Water causes breakdown of protective lining, bacteria _____ Acute= localized. Chronic = Secondary infection from tympanic cavity discharge, multiple pathogens Malignant = Occurs in immunocompromised patients	18	1	true
fed Day	First episode at age less than 6 months Siblings in home Patient is male Formula _____ care attendance Cigarette smoke in home Cold weather months of the year	20	1	true
Management of OE	Answer: 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	21	0	false
Causative organisms	Answer: Strep pneumonia (40-50%), H flu (40%), Moraxella catarrhalis, ALSO Group A Beta hemolytic strep, Staph aureus, anerobic bacteria, viruses	22	0	false
OM with effusion	Answer: 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	23	0	false