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