CMN 568 Exam 1 Questions And Correct
Answers
Proper otoscopic technique
Proper technique:
Note that he is bracing his finger against the child's cheek, if patient moves, so does otoscope
OTITIS EXTERNA
Cellulitis of the soft tissues of the external auditory canal
-AKA swimmers ear
Otitis ex...
Proper otoscopic technique
Proper technique:
Note that he is bracing his finger against the child's cheek, if patient moves, so does otoscope
OTITIS EXTERNA
Cellulitis of the soft tissues of the external auditory canal
-AKA swimmers ear
Otitis externa pathogens
Pseudomonas aeruginosa
Staphylococcus aureus
Aspergillus or other fungi (especially diabetics)
Risk Factors otitis externa
Moisture in the ear from swimming, showering, etc
Trauma to the external canal from Q-tips, ear plugs, hearing aids, or scratching
Keeping ears too clean removes protective cerumen and increases pH which promotes bacterial
growth
s/s of otitis externa
Edema and erythema of external canal, may be swollen
shut
Severe ear pain, made worse by movement of the pinna or tragus
Purulent discharge from the external canal, canal may be filled with debris, making visualization
of the TM difficult or impossible
May have periauricular or cervical lymphadenopathy
Differential Dx of otitis externa
Acute Otitis Media with TM rupture or patent PE tubes
• Furunculosis of the ear canal, Mastoiditis
treatment of otitis externa
Careful exam to see if the TM is intact. If you can not visualize the TM due to swelling or debris,
you MUST assume perforation and manage accordingly.
-Gentle removal of debris from canal if possible. If TM is intact, gently irrigate with NS and a
bulb syringe. Do NOT irrigate if TM not visualized.
Pain control: Tylenol or Ibuprofen for mild pain, may need narcotic analgesic for severe pain.
Antibiotics for otitis externa
-Topical eardrums unless signs of system infection
-Fluoroquinolone drops are first line
-Neomycin/polymyxin b/hydrocortisone cream
-oral atnitibiotcs for systemic
Fluoroquinolone drops
• Covers pseudomonas and Staph
• Safe to use if TM is perforated or PE tubes are in place
Ciprofloxacin/dexamethasone (Ciprodex) contain cipro and a
steroid for inflammation. (4g gtts BID x 7 days)
Ciprofloxacin otic alone (.25ml BID x 7days)
Ciprofloxicin otic liquid to gel (Otiprio): 0.2ml in ear x 1
Ciprofloxacin/dexamethasone (Ciprodex)
contain cipro and a
steroid for inflammation. (4g gtts BID x 7 days)
Ciprofloxacin otic alone
(.25ml BID x 7days)
Ciprofloxicin otic liquid to gel (Otiprio)
0.2ml in ear x 1
Neomycin/ Polymyxin B/ Hydrocortisone (Cortisporin otic)
• 3-4 gtts TID-QID for 7-10 days• Do NOT use if TM is perforated or PE tubes in place
Use of an ear wick
-If canal is swollen, insert a Pope ear wick to allow antibiotic drops to get deep into canal.
-Insert dry wick, then moisten with ear drops to expand
-Wick will fall out when swelling decreases
Prevention of otitis externa
• Avoid vigorous ear cleaning which removes protective cerumen and changes pH
• Avoid use of Q-tips which can damage ear canal
• Use drying agents after swimming:• 2-3 gtts of 1:1 solution of white vinegar/ 70% ethyl alcohol
• Commercial products such as Swim Ear drops• Acidify and dry canal to inhibit bacterial
growth
Acute otitis media (AOM)
• Acute infection of the middle ear space with inflammation and effusion
• 2 things must be present to diagnose:
A bulging TM
Middle ear effusion (MEE) as demonstrated by pneumatic otoscopy or tympanometry
Pathogens of AOM
• Streptococcus pneumoniae (35-40%) • Haemophilus influenzae (30-35%)• Moraxella
catarrhalis (15-25%)• Streptococcus pyogene
Risk Factors for AOM
Eustachian tube dysfunction: equalizes pressure and allows drainage from middle ear. Tubes in
infants are shorter, wider, floppier and more horizontal that in adults, making them prone to
dysfunction.
Bacterial colonization of the nasopharynx with AOM pathogens
Viral URI: inflammation of eustachian tubes impairs function leading to middle ear effusion
Smoke exposure: inflames eustachian tubes, impeds drainage, and increases pathogen
colonization
Clinical Manifestations of AOM
• Symptoms:• Ear pain: pulling or tugging on ear in young infant • Fever
Signs:
-Bulging, inflamed (erythematous) TM
Signs of effusion: decreased mobility of TM on insufflation with pneumatic otoscope or flat
tympanometry wave
-Loss of bony landmarks and light reflex on otoscopic exam
-Yellow or white effusion behind TM (pus)
-Purulent drainage (otorrhea) if TM is ruptured or patent PE tubes in place
Treatment of AOM
Pain management: ---AOM is painful. Remember to advise use of acetaminophen or ibuprofen
for pain relief
-Observation Option: A period of "watchful waiting" is appropriate in otherwise healthy children
> 6mo with the ability to be closely followed and antibiotics provided if symptoms worsen or fail
to improve in 48-72 hour
Antibiotic Selection AOM first line
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