NU674 FINAL EXAM WELL
WRITTEN REVIEWED SUMMARY
Acute Otitis Media (AOM): clinical manifestations
Major:
Acute onset
Middle ear effusion
Bulging TM with loss of bony landmarks
Associated:
Fever, pain, muffled sound, drainage, recent URI, dizzy
Persistent: > 2 courses abx w/o resolution
Recurrent: > 3 in 6 mos or 4 episode in a year
AOM Risk Factor
Anatomy - flat eustachian tubes
Cold climate
Cleft palate
URI
Allergic rhinitis
First occurence <1yo
Bottle feed supine
Fhx
Otitis Media with Effusion
Asymptomatic, possible full feeling
No fever ir otalgia
,Dull TM
visible air bubbles
AOM tx Peds
<2mos
Amoxicillin/augmentin 30mg/kg/day divided BID x 10 days
>3mos
80-90mg/kg/day divided BID or TID x 10 days
AOM peds observation approach
Unilateral non-severe illness (mild otalgia <48hr, T <102F)
over 6 mos of age
80% resolve no abx
*follow-up 48-72 hours*
Abx if no improvement or worsening
AOM tx adults
Amoxicillin/augmentin 875mg BID x 10 days
Alt:
Cefdinir 600mg/day x 10 days
Doxy 100mg BID x 10 days
AOM supportive care
Improve 48-72 hrs w abx
Tylenol/ibuprf for pain fever
Amethocaine/phenazone ear drops
Nasal steroids for eustachian tube dysfxn
NOT RECOMMENDED: may prolong effusion
Decongestants
Expectorants
Antihistamines
tympanostomy tubes
3 episodes of AOM in 6 months or 4 episodes in 1 yr
Last 6mos to 2 yrs
,Fall out on own. tm heals.
Children w effusions > 3 mos require close monitoring of
hearing / language
Tympanic membrane rupture
Sudden pain then relief and drainage
Heal w/o intervention
*keep ear dry*
Otitis externa clinical manifestations
Caused by heat, humidity, trauma by foreign objects,
water exposure
Itchy, exquisitely tender
Purulent drainage
Crusted debris
Edematous canal or external ear
Malodorus
Swillen preauricular nodes
Red flags: fever, cellulitis, edema that effects admin of
drops, cranial nerve palsy
Otitis externa tx
Neomycin/polymyxin B and HCT (cortisporin) drops
Adults 4 gtts QID
Peds 3 gtts QID (>2yo)
Cirpo/dexamethasone (ciprodex) 4 drops BID
Ofloxacin drops
Adulst 10gtts >13yo
Peds 5 gtts
Once daily
, All 7-10 days!
*Fluoroquinolones are tx of choice for perforated or
ruptured TM!!*
Can use wick to expand ear canal, allow meds to travel
deeper
Cerumen impaction clinical manifestations
Hearing loss, fullness, it hing, otalgia, tinnitus, cough,
imbalance
Dx with otoscope - causes s/s or prevents inner ear
assessment
Cerumen impaction tx
Irrigation, cerumenolytic, manual removal
Preferred technique - manual removal
Abnormal anatomy
Immunocompromise
Hx of ear surgery
TM perf or rupture
Eye complaint priority assessments
Visual acuity
PERRLA
Extraocular movements
Bacterial conjunctivitis clinical manifestations
Typically unilateral can be bilateral
Eyelids stuck shut
Drainage, crust
Especially in the AM
Bacterial conjunctivitis tx
WRITTEN REVIEWED SUMMARY
Acute Otitis Media (AOM): clinical manifestations
Major:
Acute onset
Middle ear effusion
Bulging TM with loss of bony landmarks
Associated:
Fever, pain, muffled sound, drainage, recent URI, dizzy
Persistent: > 2 courses abx w/o resolution
Recurrent: > 3 in 6 mos or 4 episode in a year
AOM Risk Factor
Anatomy - flat eustachian tubes
Cold climate
Cleft palate
URI
Allergic rhinitis
First occurence <1yo
Bottle feed supine
Fhx
Otitis Media with Effusion
Asymptomatic, possible full feeling
No fever ir otalgia
,Dull TM
visible air bubbles
AOM tx Peds
<2mos
Amoxicillin/augmentin 30mg/kg/day divided BID x 10 days
>3mos
80-90mg/kg/day divided BID or TID x 10 days
AOM peds observation approach
Unilateral non-severe illness (mild otalgia <48hr, T <102F)
over 6 mos of age
80% resolve no abx
*follow-up 48-72 hours*
Abx if no improvement or worsening
AOM tx adults
Amoxicillin/augmentin 875mg BID x 10 days
Alt:
Cefdinir 600mg/day x 10 days
Doxy 100mg BID x 10 days
AOM supportive care
Improve 48-72 hrs w abx
Tylenol/ibuprf for pain fever
Amethocaine/phenazone ear drops
Nasal steroids for eustachian tube dysfxn
NOT RECOMMENDED: may prolong effusion
Decongestants
Expectorants
Antihistamines
tympanostomy tubes
3 episodes of AOM in 6 months or 4 episodes in 1 yr
Last 6mos to 2 yrs
,Fall out on own. tm heals.
Children w effusions > 3 mos require close monitoring of
hearing / language
Tympanic membrane rupture
Sudden pain then relief and drainage
Heal w/o intervention
*keep ear dry*
Otitis externa clinical manifestations
Caused by heat, humidity, trauma by foreign objects,
water exposure
Itchy, exquisitely tender
Purulent drainage
Crusted debris
Edematous canal or external ear
Malodorus
Swillen preauricular nodes
Red flags: fever, cellulitis, edema that effects admin of
drops, cranial nerve palsy
Otitis externa tx
Neomycin/polymyxin B and HCT (cortisporin) drops
Adults 4 gtts QID
Peds 3 gtts QID (>2yo)
Cirpo/dexamethasone (ciprodex) 4 drops BID
Ofloxacin drops
Adulst 10gtts >13yo
Peds 5 gtts
Once daily
, All 7-10 days!
*Fluoroquinolones are tx of choice for perforated or
ruptured TM!!*
Can use wick to expand ear canal, allow meds to travel
deeper
Cerumen impaction clinical manifestations
Hearing loss, fullness, it hing, otalgia, tinnitus, cough,
imbalance
Dx with otoscope - causes s/s or prevents inner ear
assessment
Cerumen impaction tx
Irrigation, cerumenolytic, manual removal
Preferred technique - manual removal
Abnormal anatomy
Immunocompromise
Hx of ear surgery
TM perf or rupture
Eye complaint priority assessments
Visual acuity
PERRLA
Extraocular movements
Bacterial conjunctivitis clinical manifestations
Typically unilateral can be bilateral
Eyelids stuck shut
Drainage, crust
Especially in the AM
Bacterial conjunctivitis tx
