Congestive Heart Failure - Ruggles Service Corporation
ALERTSMastoiditisPerforated TMPersistent or recurrent OMAGE CONSIDERATIONSOtitis Media: infant, toddler >school age, adolescentDIFFERENTIAL DIAGNOSISEar foreign bodyOtitis ExternaOtitis MediaParotitisReferred pain from oropharynx or teethTemporomandibular joint painEVALUATIONHistory Onset and quality of pain, associated fever, URI, ear drainage, ear trauma, recent activities (i.e. swimming)Physical ExamHEENT: otoscopic findings, oropharynx, dentitionDiagnostic findings Ear: Tympanic membrane findings: Position, erythema, effusion, mobility, light reflex, perforationPinna: assess for pain with traction, foreign body, lacerationConcerning findings Mastoiditis: proptosis of the ear, swelling or erythema over the mastoid Parotitis: swelling anterior and/or inferior to the earDiagnostic TestsDiagnostic Procedures Pneumatic otoscopyMANAGEMENT Transfer/Admission ConsiderationsMastoiditis Suppurative parotitisEar foreign body of organic materialDeeper ear canal foreign bodyLaceration to the auricle involving cartilageOtitis MediaTreatment First LineOtitis media with intact TM: Amoxicillin (80-90 mg/kg divided BID for 10 days)Otitis media with tympanostomy tubes: Ofloxacin or CiprodexOtitis media with perforation should be treated with oral and topical antibioticsSecond LineAugmentin (80-90 mg/kg of amoxicillin component divided BID for 10 days). Use high dose formulation onlyAzithromycinSupportiveFever and pain relieverComplementary & Alternative TherapiesXylitol may play a role in preventionAntihistamine or over the counter cold remedies are not recommendedSurgery / Other Procedures Persistent effusion may require tympanostomyFollow UpOutpatient Referral Follow up in 10-14 days for reevaluation, sooner with persistent symptomsConsider specialist for persistent effusion, recurrent infectionsAnticipatory Guidance May take 24-48 hours for symptoms relief after starting antibioticsSigns and Symptoms to return Persistent fever, ear drainageEar swelling, proptosis, mastoid tenderness or erythemaPrognosis, ComplicationsMastoiditisOtitis Media with perforationOtitis ExternaTreatment First Line Topical antibiotic drops: CortosporinConsider wick placement for significant debris to improve delivery of dropsSecond Line Ciprodex or OfloxacinSupportive Pain relieverAvoid swimming or use ear plugs until treatment is completedFollow Up Outpatient Referral Resistant/Persistent infections may be mycotic, refer to Ear, Nose and Throat specialistAnticipatory Guidance Pain relieverPain may persist for 1-2 dyas affter treatment is startedPreventative measures with OTC swimmers ear drops have unknown benefitActivity, DietRefrain from swimming or use ear plugs until therapy is complete Signs and Symptoms to return Worsening or persistent ear painPrognosis, ComplicationsFever is rare and should prompt concern for complicationsCellulitis of the Pinna can develop if untreatedEar Foreign Body (Canal) see ProceduresEar Foreign Body (Soft Tissue) see ProceduresREFERENCESADDITIONAL RESOURCESAAP Otitis Media ................
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