-
Hearing screening should be done by ______.
1 month
-
Dx of hearing loss should be done by _________.
3 mos
-
Entry into early intervention services for hearing loss should be done by ______.
6 mos
-
Measures the initiation of sound-induced electrical signals in the cochlea.
Auditory Brainstem Response (ABR)
-
Measures response of inner ear to brief clicks or tones.
Otoacoustic Emissions (OAE)
-
Test used if child does not pass Otoacoustic Emissions (OAE).
Auditory Brainstem Response (ABR)
-
Measures functioning of the peripheral auditory system and neurologic pathways r/t hearing.
Auditory Brainstem Response (ABR)
-
At what age should a child startle to loud sounds, quiet to mother's voice, cease activity momentarily when sound is made at conversational level?
0-4 mos
-
At what age should a child correctly localize to a sound & begin to imitate sounds?
5-6 mos
-
At what age should a child correctly localize sound in ANY plane & respond to name?
7-12 mos
-
At what age should a child point toward unexpected sound or to familiar persons when asked?
13-15 mos
-
At what age should a child follow simple directions?
16-18 mos
-
At what age should a child point to body parts when asked?
19-24 mos
-
Most common culprits of acute otitis media?
- S. pneumoniae
- H. flu
- M.catarrhalis
-
Acute infection of the middle ear.
Acute otitis media
-
Dx of acute otitis media requires presence of what three things?
- Recent abrupt onset of ear pain, irritability, otorrhea, fever
- Middle ear effusion confirmed by bulging TM, limited or decreased mobility, air-fluid level
- S/S of middle ear inflammation: red TM, otalgia, interfering with sleep/activity
-
In which cases of acute otitis media is observation an option rather than abx?
- 6 mos or older: unilateral AOM w/o otorrhea
- 2 yrs or older: bilateral AOM w/o otorrhea
-
In which cases is abx therapy recommended for AOM?
- AOM with otorrhea
- unilateral or bilateral AOM with severe symptoms
- if 6mos-2yrs: bilateral AOM w/OUT otorrhea
-
First line tx for AOM.
- Amoxicillin 80–90 mg/kg/day divided bid
- Amoxicillin/clavulanate 90 mg/kg/day divided bid (center-based daycares)
-
Concominant conjunctivitis with AOM with a blister on the ear drum (Bullous Myringitis), what is most likely the cause?
H. flu (nontypeable)
-
Otorrhea w/ erythematous TM should prompt what thoughts?
- the kid has tubes or
- perforated TM
-
Tx for Otitis Media w/ Effusion
- observation
- usually clears by 3 mos
-
Champagne bubbles means what?
OME (otitis media w/ effusion)
-
IF you notice redness and swelling over the mastoid process, what does this mean?
mastoiditis and immediate hospitalization w/ IV abx
-
Dx of otitis externa is ALWAYS assoc with what?
edema of ear canal
-
Pain when pulling pinna or pressure over tragus indicates what?
otitis externa
-
Tx for otitis externa.
- topical otic prep/abx (quinolones)
- acetaminophen or ibuprofen PO
- add PO abx if fever or severe lymphadenitis
-
Avoid ________ when treating otitis externa. Why?
- neomycin or
- gentamycin
- b/c assoc ottox if they reach middle ear (esp if cannot see TM!)
-
Itching as a precursor to pain is a s/s of?
otitis externa
-
Erythema, thick clumpy otorrhea; cerumen is white and soft/cheesy; palpable tender lymph nodes periauricular.
Otitis Externa
-
An epidermal inclusion cyst of middle ear or mastoid (cauliflower-like).
cholesteatoma - always refer to ENT for removal
-
_______ can occur with acute URI, eustachian tube dysfunction or before/after AOM.
OME
-
New onset otorrhea not due to otitis external, or on TM visualization.
AOM
-
Mild bulging of TM and recent (less than 48 hrs) onset of ear pain or intense erythema of TM.
AOM
-
Kids older than 6 mos should only be prescribed abx for AOM when?
- severe symptoms
- (like otalgia > 48 hrs or temp > 102.2)
-
When would you use amox/clavulanate to tx AOM?
- if has been tx w/ amox in last 30 days OR
- has concurrent purulent conjunctivitis
-
_______ can cause an auricular DO with calcification of cartilage/painless nodules.
Addison's disease
-
Painless uric acid crystal deposits in external ear.
tophi
-
Hard nodules in the external ear can be secondary to __________.
chronic arthritis
-
Presents as a blue doughy mass and, if not drained, can result in "cauliflower ear"
hematoma
-
Fusion of the stapes over the oval window; common cause of hearing loss in older adults; can be surgically corrected.
otosclerosis
-
caused by DO of the cochlea and tretrocochlear region including the auditory nerve and its connection to the brainstem.
sensorineural hearing loss
-
__________ is the principal cause of cochlear damage.
noise trauma
-
Gradual degeneration within the cochlea; occurs with aging. How is this treated?
- presbycusis
- Irreversible but can be treated w/ hearing aid if some hair cells are left
-
__________ is sensorineural hearing loss accompanied by vertigo.
labyrinthitis
-
Retrocochlear sensorineural hearing loss involves what three things?
- auditory nerve
- brainstem
- CNS
-
___________ can be sequelae of CNS infection, CV injury, demyelinating diseases, or neoplasms.
Retrocochlear sensorineural hearing loss
-
Normal threshold of hearing.
0-20 dB
-
At _____ dB, there is difficulty hearing faint or distant speech and requires favorable seating.
40
-
At _____ dB, normal speech is understood at 3-5 feet.
55
-
At _____ dB, loud voices can be heard at one foot from the ear.
90
-
Rushing, pulsating, humming sound with positional changes is called _______ and can indicate what?
- pulsatile tinnitus;
- tumor
- increased ICP, or
- vascular abnormalities
-
Tinnitus is often accompanied by _______ hearing loss.
high frequency
-
Severe vertigo, n/v, aggravated by head movement; possible tinnitus & hearing loss.
labyrinthitis
-
Most severe symptoms of labyrinthitis subside when?
within 2-3 days; can last up to 4-5 days
-
What symptom may recur for months with labyrinthitis?
vertigo with sudden head movement
-
labyrinthitis commonly occurs after what?
URI or acute inflammation of inner ear
-
What is often a severe symptom with labyrinthitis?
vertigo
-
___________ can cause similar symptoms as labyrinthitis but does not affect hearing.
vestibular neuritis
-
___________ is almost always present upon PE for labyrinthitis.
- spontaneous nystagmus
- directed in opposite dxn of affected ear
-
Tx of labyrinthitis.
- bed rest (side lying w/ affected ear up)
- Meclizine 12.5-50mg q 6 hrs
- sedatives & antiemetics PRN
- abx if bacterial suspected (most are viral)
- refer if not resolved in 4-6 wks
|
|