Conditions in the Pediatric Ear

By Barbara Kolk-Seda MS PA-C

AIM• To become familiar with the equipment use in examining the

pediatric ear

• To be able to recognize the signs and symptoms of conditions in the pediatric ear

• To be able to recommend treatment modalities for conditions in the pediatric ear

Equipment

• Otoscope with insephalator bulb• Pneumatic Otoscope• Curette• Irrigation equipment• Tympanogram

6 year old female brought in by father. She is C/O pain in her left ear for 24 hours. Dad notes she was up all night crying, he gave Motrin at 3 am with minimal relief.

Otitis Media VS Otitis Externa

Otitis Media• URI• Pain• Fever• +/- D/C • Irritability • Anorexia• Pressure/ popping in ear• No discomfort External Ear

Otitis Externa• Severe pain• Swelling/ Erythema Pinna/

posterior ear• Tenderness with pressure

on tragus/ traction on pinna• Swelling of canal • Discharge• Afebrile

Otitis Externa“SWIMMERS EAR”

• Infection of the ear canal• May or may not have a H/O swimming• Loss of protective function of cerumen

• Trauma• Contact dermatitis

• Common organisms• Staph. aureus • Pseudomonas aeruginosa

Possible Complications:• Facial Cellulitis• Malignant cellulitis ( spreads to skull base causing

osteomyelitis)

OE (cont.)

Ddx:• Perforated TM• Mastoiditis

Preventative Treatment:• Avoid over use of Q-Tips• Preventative:

• Instill 2-3 gtts of 1:1 soln. white vinegar and 70% Ethyl alcohol after swimming

Otitis ExternaTreatment-

• Analgesia• Wick placement • Topical Abx soln.

• Floxin Otic: < 13 yrs 5 gtts to affected ear OD x 7 days, > 13 yrs 10 gtts OD x 7 days

• Ciprodex Otic: 4 gtts BID x 7days• Oral Abx• Avoid submerging head under water • Ear Plugs

Otitis Media

Inflammation of the middle ear with effusion often leading to infection

Classified as:• Acute Otitis Media (AOM)

• Acute Otitis Media w/ Perforation

• Otitis Media with Effusion (OME)

• Chronic Suppurative Otitis Media

• Bullous Myringitis

Otitis Media (Cont.)

AOM

Clinical Presentation:• Otalgia• Fever• Irritability• Anorexia• Vomiting• Otorrhea

Findings on PE:• External Ear normal non-tender• +/- Anterior Cervical adenopathy• Canal w/o erythema or swelling• TM dull/ loss of landmarks, erythematous, bulging, +/-

bullous, effusion (serous, yellow or whitish)• Perforation indicted by drainage in the canal may occlude TM

Hematoma of the Pinna

Results from trauma causing a hematoma between the perichondrium and cartilage.

Upper pinna appears boggy purple, cartilage folds obscured untreated may lead to “Cauliflower Ear”

Urgent referral to ENT

Congenital Malformations• Agenesis (atresia)

• Conductive hearing loss• Ref ENT & audiology for eval.• MRI to evaluate internal structures

• Microtia • Small• Collapsed• Earlobe only• May have associated atresia• More common in Native Americans, and Latinos

• Folded Down “Lop Ears” or Protruding Ears• Taping• Surgical correction

Congenital Malformations

Other Common Findings:• Preauricular tags• Ectopic Cartilage• Fistulas• Sinus Tracts• Cysts• Low set ears (Potter Syndrome, Down Syndrome)

Concerns:CosmeticAll should have their hearing checkedConsider Renal Sono

Hearing Loss

Conductive VS Sensorineural

Congenital vs Hereditary vs Acquired

Hearing Loss

Conductive: blockage of sound transmission between external ear canal and cochlear receptor cells.

• Middle Ear Effusion / eustachian tube dysfunction• Perforation of TM• Cerumen Impaction• Cholesteatoma • Ossicular fixation or discontinuity• atresia• Trauma / swelling of canal

Hearing LossSensorineural: arises from defect in cochlear hair cells or the auditory nerve (CN VIII). 2/ 1,000 live births. Most common congenital sensory impairment.

• Congenital • Hereditary • Nonhereditary

• Birth weight less than 1,500g• Low APGAR• Craniofacial anomalies• Hypoxia• In-Utero Infections (TORCH)• Hyperbilirubenemia requiring exchange transfusion• Mechanical Ventilation >5 days

Hearing LossAcquired:

• Delayed Onset• Alport syndrome• Autosomal dominant / nonsyndromic• Medication Induced

• Aminoglycosides• diuretics

• Meningitis• Autoimmune• Trauma

• Acoustic• Physical

• Infections• Syphilis• Lyme• CMV (congenital or delayed)

Hearing Loss

Over 400 genetic syndromes that involve hearing loss

If hearing loss is noted exam should be geared towards looking for other features that may a syndrome.

70% of hereditary hearing loss is nonsyndromic

Treatment:• Prevention• Eliminate treatable causes (cerumen)• Referral to ENT and Audiologist for evaluation

• Surgery • Tubes• Cochlear implantation

• EI