Pediatric ENT Exam
Inflammation of middle ear, temporal bone, + mastoid air cells - Acute otitis media
Peak age for AOM - 6-18M
RFs for AOM - Ages 6-18M, second hand smoke, NOT being breastfed, daycare, pacifier/bottle use
MCC of AOM - Strep pneumo, H flu, M catarrhalis
CMs of AOM - Fever, otalgia, ear tugging, conductive hearing loss
Bulging / red TM w/ effusion, loss of landmarks
Most sensitive test for AOM - Pneumatic otoscopy — decr TM mobility
Tx for AOM - Amoxicillin 80-90 mg / kg / day for 10-14d
—Second line: augmentin, cephalosporins
—PCN allergy: azithromycin, clarithromycin
Inflammation of the external auditory canal - Otitis externa
RFs for otitis externa - Water immersion, local mechanical trauma (ie use of Qtips), aberrant ear wax
MCC of otitis externa - Pseudomonas aeruginosa
CMs of otitis externa - Ear pain, pruritis of ear canal
Auricular d/c, ear pressure, ear fullness
Pain on traction of ear canal / tragus
Conductive HL
Tx of otitis externa - -protect ear from moisture
, -remove debris
-topical ABX (cipro/dexamethasone, ofloxacin, neomycin/polymyxin B/hydrocortisone)
*DO NOT USE NEOMYC/POLYMYX B/HYDROCORT IF EAR PERFORATION!!!
Invasive infection of the external auditory canal + skull base; a complication of AOE - Malignant /
necrotizing otitis externa
RFs for malignant / necrotizing OE - Immunocompromised (DM is MC), high dose steroids, chemo,
advanced HIV
Clinical manifestations of necrotizing otitis externa - Otorrhea (ear discharge), pain at TMJ w/
chewing, cranial nerve palsies
Severe auricular pain on traction of ear canal or tragus
Will note frank necrosis of ear canal skin + granulation tissue of the cartilaginous jx of ear canal
Tx for necrotizing / malignant OE - Admit to hospital + IV ciprofloxacin
Infection of the mastoid air cells of the temporal bone, largely occurring in those < 2yo; usually a
complication of AOM - Mastoiditis
Clinical manifestations of mastoiditis - Deep ear pain worse @ NIGHT
Fever, lethargy, malaise
Signs/sx of AOM (bulging, red TM)
Mastoid tenderness, edema, erythema
Forward protrusion of ear
Dx of mastoiditis - CT scan w/ contrast of temporal bone
Tx for mastoiditis - Admit to hospital for IV ABX [vanco or clindamycin for 4W] + Myingotomy (middle
ear drainage)
+/- tympanostomy tube placement
Inflammation of middle ear, temporal bone, + mastoid air cells - Acute otitis media
Peak age for AOM - 6-18M
RFs for AOM - Ages 6-18M, second hand smoke, NOT being breastfed, daycare, pacifier/bottle use
MCC of AOM - Strep pneumo, H flu, M catarrhalis
CMs of AOM - Fever, otalgia, ear tugging, conductive hearing loss
Bulging / red TM w/ effusion, loss of landmarks
Most sensitive test for AOM - Pneumatic otoscopy — decr TM mobility
Tx for AOM - Amoxicillin 80-90 mg / kg / day for 10-14d
—Second line: augmentin, cephalosporins
—PCN allergy: azithromycin, clarithromycin
Inflammation of the external auditory canal - Otitis externa
RFs for otitis externa - Water immersion, local mechanical trauma (ie use of Qtips), aberrant ear wax
MCC of otitis externa - Pseudomonas aeruginosa
CMs of otitis externa - Ear pain, pruritis of ear canal
Auricular d/c, ear pressure, ear fullness
Pain on traction of ear canal / tragus
Conductive HL
Tx of otitis externa - -protect ear from moisture
, -remove debris
-topical ABX (cipro/dexamethasone, ofloxacin, neomycin/polymyxin B/hydrocortisone)
*DO NOT USE NEOMYC/POLYMYX B/HYDROCORT IF EAR PERFORATION!!!
Invasive infection of the external auditory canal + skull base; a complication of AOE - Malignant /
necrotizing otitis externa
RFs for malignant / necrotizing OE - Immunocompromised (DM is MC), high dose steroids, chemo,
advanced HIV
Clinical manifestations of necrotizing otitis externa - Otorrhea (ear discharge), pain at TMJ w/
chewing, cranial nerve palsies
Severe auricular pain on traction of ear canal or tragus
Will note frank necrosis of ear canal skin + granulation tissue of the cartilaginous jx of ear canal
Tx for necrotizing / malignant OE - Admit to hospital + IV ciprofloxacin
Infection of the mastoid air cells of the temporal bone, largely occurring in those < 2yo; usually a
complication of AOM - Mastoiditis
Clinical manifestations of mastoiditis - Deep ear pain worse @ NIGHT
Fever, lethargy, malaise
Signs/sx of AOM (bulging, red TM)
Mastoid tenderness, edema, erythema
Forward protrusion of ear
Dx of mastoiditis - CT scan w/ contrast of temporal bone
Tx for mastoiditis - Admit to hospital for IV ABX [vanco or clindamycin for 4W] + Myingotomy (middle
ear drainage)
+/- tympanostomy tube placement
