Peds: Ch 3 (Test#2)

22. What is the frequent consequence of eustachian tube malfunctions? 1.

The air trapped in the middle ear cavity is absorbed by the mucosal lining of the middle ear, crating negative middle ear pressure and ultimately, transudation of fluid into the cavity.

29. Many pathogens are resistant to common antibiotics, no single antimicrobial agent is suitable for all patients with otitis media. What action maybe taken by the otologist with difficult cases? 1.

Tympanomy; incision of tympanic membrane

41) Acute otitis media in an inflammatory disorder caused by microorganisms in the middle ear, usually a sequel to _____________.

a URI (upper respiratory infection)

36) List several complications of untreated otitis media with effusion: 1. 2. 3. 4.

1. hearing loss 2. perforation of the tympanic membrane (with or without effusion) 3. cholesteatoma 4. adhesive otitis media

35) The treatment of otitis media is controversial. In 1994 the Agency for Health Care Policy and Research (AHCPR) of the US Dept of Health and Human Services convened a panel of experts to set some guidelines for the clinical practice of otitis media. For the initial management of otitis media, what treatment is recommended? 1. They suggest __________ or _________. No PE tubes are recommended. After 3 months, if the hearing loss is 20 dB HL or greater, what treatment is recommended? 2. ________ or __________ may be chosen to manage otitis media. After 4-6 months of otitis media with effusion, what treatment is recommended? 3. Myringotomy tubes List some management procedures that are not recommeded at any time for otitis media with effusion. 4. 5. 6.

1. observation or antibiotic therapy 2. antibiotic therapy or myringotomy 4.steroid medications 5.antihistamine/decongestant medications 6.adenoidectomy, and tonsillectomy

56) Although middle ear effusion is common among neonates, otoscopy is not routinely performed as the TM is difficult to visualize because: 1) 2)

1. the external ear canal is flexible and often collapses. 2. the TM lies in a nearly horizontal plane

51) Tos (1983) reviewed surgical results from 122 children operated on for removal of cholesteatoma, and found a recurrence in ___% of patiends with this skin tumor. Thus, follow-up visits are important.

12

50) Cholesteatomas that are untreated by be dangerous. Explain. 1.

It can result in bone erosion leading to deafness, brain abscess, and meningitis; death can sometimes occur.

19) Inflammation of the Eustachian tube, along with allergic rhinitis (inflammation of the nasal mucosa), is a common cause of___________.

MEE (middle ear effusion).

10) The fluid or discharge may be characterized as serous, purulent, or mucoid. Define these terms. 1. 2. 3.

Serous: thin, watery liquid. Purulent: pus like liquid. Mucoid: thick, viscid, mucus like liquid.

14) The incidence of otitis media is a function of age, gender (more common in ____, race (native American Eskimos, and whites have higher incidence than blacks), genetic factors, socioeconomic status, season, and climate.

boys

47) When a retraction pocket (due to severe negative pressure in the middle ear) forms in the superior portion of the TM, the development of a ____________ is probable.

cholesteatoma

52) Define acute/chronic mastoiditis: 1.

acute: is an inflammation of the ciliated mucosa of the antrum. chronic: occurs with chronic inflammation of the membrane lining the mastoid antrum and ciliated cells.

57) Balkany et al. (1978) reported results from examining 125 consecutive infants from the neonatal intensive care unit and found middle ear effusion (MEE) to be present in the 30 %. They caution that unrecognized middle ear fluid may act as __________.

...

58) The age at which tympanometry becomes useful for detecting MEE in infants is not fully agreed on, but many clinicians believe _______________.

...

11)d The total cost related to the management of otitis media in the US is estimated to be ____________ per year. Nearly ___________ visits to physicians per year are estimated for otitis media. On any winter day in the US, up to 30% of children have an abnormal middle ear condition.

$5 billion; 30 million.

30. Define Myringotomy. What is its purpose? 1. 2.

1) A surgical incision of tympanic membrane and is performed in the lower half of the tympanic membrane to avoid damage to middle ear ossicles. 2) To provide instant relief from pain, to drain fluid from middle ear space, and help initiate rapid recovery from middle ear disease.

15) List some socioeconomic risk factors: 1. 2. 3.

1) Over crowding with poor sanitation. 2) Inadequate diet. 3) Absence of routine healthcare. 4) Secondary cigarette smoke exposure. 5) Possibly sleep position.

59) At what age and how often should screening language tests and screening hearing tests be conducted in promary care physicians' offices? 1. 2.

1. 2.

9) Define acute, subacute, and chronic otitis media. 1. Acute = 2. Subacute= 3. Chronic=

1. Acute= 0 to 21 days. 2. Subacute= 22 days to 8 weeks. 3. Chronic= more than 8 weeks.

53) List some complications of untreated mastoiditis: 1. 2. 3.

1. Meningitis 2. Brain abcess 3. Cerebellar access 3. Facial Nerve Paralysis

61) Hearing aids may in recommend in children with persistant conductive hearing loss if: 1. 2. Continual guidance by an audiologist or speech therapist is obtained 3. A total suppoer system by physician, parent, and therapist. 4.

1. Parents are highly motivated 4. A period of diagnostic therapy with loaner hearing aid is initiated to judge the effectiveness of the aid.

5) The eustachian tube have three general purposes. These are: 1. 2. 3.

1. Protection of middle ear from invading microbes. 2. Clearance of middle ear secretions. 3. Equalization of pressure between the middle ear space and the nasopharynx.

40) Three symptoms of acute otitis media are: 1. 2. 3.

1. Severe ear pain 2. Redness of the tympanic membrane 3. Fever

28. The most common infective pathogens that causes otitis media are: 1. 2. 3.

1. Streptococcus pneumoniae. 2. Haemophilus influenzae. 3. Moraxella catarrhalis 3. Pneumonia.

6) How does the child's eustachian tube differ from an adult? 1.

1. The child's eustachian tube is short, horizontal, and composed of flaccid cartilage, whereas the adult eustachian tube lies in a more vertical position.

60) Don't Wait. A child should have the following skills by the ages listed below: 1. ___months: 3 word vocabulary 2. ___months: 25 word vocabulary and several 2 word sentences. 3. ___months: at least a 50 word vocabulary and 2 word sentences consistently.

18; 24; 30

12)Half of the children who have one ear infection before age ___ will have 6 or more episodes in the following 2 years. Nearly ____ of the children who suffer ear infections will require surgery to correct the problem.

1; 20%

1) According to the National Center for Health Statistics, visits to the doctor for diagnosis of otitis media increased to more than _________ in 1990. Children younger than _________ have the highest rate of visits.

25 million; 2 years of age.

2) It has been estimated that ______% to ______ % of all upper respiratory infections (URIs) in children younger than 3 years of age are associated with acute otitis media.

25; 40.

18) Brostoff et al. (1985) reported that approximately ____ % of 103 preschool children 2 to 6 years diagnosed as having otitis media with effusion experienced spontaneous recovery within 2 months without medical treatment.

80

49) Define Cholesteatoma: 1.

A growth of skin from the external ear canal which invades the middle ear space by pressing into a retraction pocket in the TM

48) Define Chronic Suppurative Otitis Media: 1.

A late stage of ear disease in which there is infection of the middle ear and mastoid as well as a "central" perforation of the TM and discharge

20. Approximately one third of children are "otitis-prone." Define this term: 1.

An otitis-prone child is the youngster who has the condition 6 or more times before the age of 6 years, or whose initial episode of otitis media was due to bacteria and occurred before the age of 1 year.

13. Otitis media is more common during the first 2 years of a child's life and then decreases as the child grows older. Why? 1.

As the child ages, the inclination of the eustachian tube increases to about a 45 degree, thereby decreasing the incidence of ear infections.

54) Define tympanoschlerosis: 1.

Follows recurrent episodes of otitis media. Hyalinized and calcified scar tissue that cause stiffening of the tympanic membrane or fusion and fixation of the middle ear ossicles.

32) What residual effect do PE tubes have on hearing? 1.

None, doesn't cause scarring and doesn't change hearing

23. The tonsils "sample" incoming bacteria and viruses and help form ________ as part of the body's immune system to resist and fight future infections. Swelling of the tonsils and adenoids may create blockage____________.

antibodies to those "germs"; around the base, or opening, of the eustachian tube.

46) Define bullous myringitis: 1.

blisters occasionally form on the TM in association with a coincident URI; the blisters, or bullae, represent an accumulation of fluid between the layers of the TM.

42) The diagnosis of acute otitis media is usually made with otoscopy based on color, _____________, and outward bulging contour of the TM.

decreased mobility

33) PE tubes are naturally pushed into the ear canal after 6-18 months, and water precautions are typically unneccessary for most children. That is, there is no benefit from the routine use of __________.

earplugs, bathing caps, or custom fitted swim molds

3) Baker (1992) has shown that ear pulling, in the absence of other symptoms, ________ usually related to ear infections.

is not.

26. The larger bore tube may aerate the middle easr better and stay in place longer, but ________.

it is more likely to leave a persistent perforation of the tympanic membrane.

34) PE tubes do not cure the ear infection. Explain: 1.

it simply controls the infection by temporarily ventilating the middle ear

37) Some intracranial complications of otitis media may include: 1.

meningitis, encephalitis, brain abscess, and sinus thrombophlebitis.

7) Fria et al. (1985) reported average air conduction thresholds from 762 children with documented ____________ (MEE). These thresholds were 27 dB HL at 500, 1000, and 4000 Hz, and 20 dB HL at 2000 Hz. Thus, the hearing configuration is ____________. Hearing in this study was approximately 10 dB worse for bilateral effusion than unilateral effusion. Bone-conduction thresholds are usually ________ by the presence of MEE.

middle ear effusion; fairly flat ; not affected.

38) In 1-15% of patients, the TM fails to heal following extrusion of the PE tube, leaving a small perforation which is treated with a minor surgical procedure known at ___________.

myringoplasty

39) The treatment of a persistant perforation generally requires a minor surgical procedure known as a ________, to seal the perforation.

myringoplasty

45) In patients with unusually severe earache or pain, ___________ may be performed to provide immediate pain relief.

myringotomy

17) Children in day care have more otitis media than do children who are cared for at home, because__________.

of endemic URIs passed among children.

43) It is not uncommon for an episode of acute otitis media to be associated with a spontaneous perforation of the TM, which results in ______________.

ottorhea

4) The underlying cause of otitis media is nearly always the result of ___________, which leads to the production of sterile fluid by the ________of the middle ear.

poor eustachian tube function; mucosal lining.

31) If otitis media is likely due to inadequate ventilation of the middle ear, then the recommended surgical treatment is ______________. If infection of the middle ear from reflux of nasopharyngeal organisms is the problem, the treatment of choice may be _____________. In most cases of chronic otitis media, both pathophysiologic conditions exist, thus both procedures may be indicated.

recommended; adenoidectomy

16) Bottle fed infants in the _____ position are more at risk for otitis media than infants who are fed while being held upright.

supine.

25. Pressure equalization (PE) tubes are left in place for several months until__________.

they naturally extrude, in hopes that the eustachian tube dysfunction has resolved naturally.

55) Paparella and Brady (1970) reviewed more than 200 patients with chronic suppurative otitis media and mastoiditis. They found a definite increase in the incidence of sensorineural hearing loss that they suggested was due ________________.

to a cochlear biochemical change created by toxic materials passed into the inner ear through the round window, resulting in gradual destruction of the organ of Corti.

24. What is the most common surgical operation performed in children? 1.

treatment of otitis media with insertion of PE tubes

8) Otitis Media may be associated with effusion or ________________ perforation.

tympanic membrane

27. The mainstay of the diagnosis of otitis media is pneumatic otoscopy which permits evaluation of _____________.

tympanic membrane mobility that is not possible by simple inspection through a simple otoscope.

44) When diagnosis of acute otitis median is in doubt, or when determination of the causative agent is in question, aspiration of the middle ear fluid is performed with __________.

tympanocentesis or myringotomy

21. The most important function of the eustachian is____________.

ventilation of the middle ear space.