the child’s ear - ocde.usthe child’s ear normal? abnormal? and what do we do next? anatomy of...
Post on 08-Mar-2018
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And…. Ear pain, discharge from
the ear, and suspected hearing loss are three of the most common and specific ear symptoms for which parents seek medical attention for their children
One study revealed more than a third of sick visits to pediatricians involved ear symptoms
Delayed diagnosis can have serious long-term sequelae including including increased medical costs, need for surgery, missed school days, and permanent hearing loss
Examining the Ear:
External ear: PinnaPreauricular areaPostauricular area including
lymph nodes, mastoid process Ear canal
Deformity: Congenital- minor to
extensive May indicate other
organ malformations Microtia/auricle
malformations Preauricular
sinuses/pits/cysts Preauricular tags
Definitions of Otitis Media:
Acute Otitis Media : 1. history of acute onset of signs and
symptoms2. the presence of middle ear effusion3. signs and symptoms of middle ear
inflammation
Acute Otitis MediaAAP/AAFP Clinical Practice Guidelines
Published in 2004 to provide recommendations for primary care clinicians for the management of uncomplicated AOM in children ages 2 months to 12 years
Based on a comprehensive review of evidence based literature related to AOM
Age Certain Dx Uncertain Dx
<6 months Antibacterial therapy
Antibacterial therapy
6 mo to 2 y Antibacterial therapy
Antibacterial therapy if severe illness, observation option if nonsevere
>2 y
Antibacterial therapy if severe illness, observation option if not severe
Observation option
Cholesteatoma:
Formed by trapped epithelial tissue that grows beneath the surface of the tympanic membrane
Most are sequelae of untreated or chronic-recurrent otitis media
Will continue to enlarge if not surgically removed
Locally destructive – can erode mastoid bone, destroy ossicles, even invade inner ear structures or skull
Definitions of Otitis Media:
Otitis Media With Effusions:
1. The presence of fluid in the middle ear WITHOUT signs or symptoms of an acute ear infection
2. May occur spontaneously because of poor eustachian tube dysfunction, before the development of AOM or as a result of AOM. Oti
Otitis Media with EffusionAAP/AAFP Clinical Practice Guidelines
Published in 2004 after multidisciplinary review of evidence-based literature of otitis media with effusion.
Recommendations regarding diagnosis and treatment of OME in children ages 2 months to 12 years
8 major recommendations made No medication intervention recommended based on lack of
evidence of benefit (decongestants, antibiotics, steroids,etc.) No recommendation made on possible benefit with allergy therapy If surgery is needed, tympanostomy tube insertion is the preferred
initial procedure.
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