Ear Pain
Most predictive sx for otitis media
ear pain and rubbing of the ear
Dx criteria for AOM:
1) + middle ear effusion 2) acute onset of signs and sx 3) Signs and sx of middle ear inflammation
Dx of recurrent AOM
1) 3 or more episodes of AOM in 6 months 2) 4 episodes in a year w/ a normal exam b/w each infecftion
Risk Factors for developing AOM
Age <2, male, genetics, previous otitis media, cigarette smoking in household, attendance at day care, and recent URI
Red flag findings in pts w/ ear pain
Ear lobule erythema, 7th CN palsy, ulceration in external ear canal, non-healing lesion in auditory canal, or tenderness over the mastoid
Ear lobule erythema in pt w/ ear pain suggests?
Erysipelas
Tx of cerumen impaction
Irrigation of auditory canal w/ water or 50:50 water-peroxide solution
7th CN palsy in a pt w/ ear pain suggests?
Malignant otitis externa
What is tympanometry?
Measures amount of a sound that transverses TM at given positive and negative pressures
What is acoustic reflectometry?
Measures amount of sound reflected off TM in decibels
Tx for otitis externa
Neomycin/polymxin B ear drops or ofloxacin ear drops
MCC of otitis externa
Pseudomonas
What is pneumatic otoscopy?
Put air in ear while looking at TM; if no movement is observed, it's assumed an effusion is there
What differentiates outer ear pain from middle ear pain and referred pain?
Reproducing pain by pulling on pinna of ear
Tx for perichondritis and furuncolosis
Cephalosporins
DDx for new-onset complete hearing loss
Cerumen impaction and foreign bodies
Tx of AOM
< 6 months: amoxicillin of 80-90 mg/kg/day or TMP-SMX > 6 months: expectant mgmt if sure of dx, illness not severe, and reliable for follow-up
Prophylaxis for recurrent AOM
Amoxicillin 1/2 daily dosage at bedtime 40 mg/kg SMX/8 mg/kg TMP QHS
Most useful clinical signs for otitis media
Bulging or cloudy TM, effusion, and loss of TM mobility