3Acute otitis mediaTh:Occlusion tubal: topical decongestan (ephedrin HCl)Presuppuration: AB for at least 7 days (ampicylin/amoxcylin/ erythromicin) & analgetic.Suppuration: AB, myringotomy.Perforation: ear wash H2O2 3% & AB.Resolution: if secrete isn’t stopped → AB is continued until 3 weeks.
4Sign of OE: Acute localized otitis externa (furuncle) Hurt if auricle is pulled backward or tragus is pressedAcute localized otitis externa (furuncle)Etiology: Staph. Aureus, Staph. Albus.Localized in an obstructed sebaceous gland or hair follicle.Only occur in outer cartilaginous portion of ear.No connective tissue below skin → very painfulTh/: topical AB. If bulging & soft → incision & drainageAcute diffuse otitis externa (swimmer’s ear)Etiology: Pseudomonas (usually), Staph albus, E. Coli.Dark, warm, humid conditions → promote bacterial growthSwollen (narrow), draining (exudate), tender canal.Very painfulTh/: Topical AB, sometimes need systemic AB.
9Atopic sign: Allergic shiner Allergic crease Facies adenoid Dark shadow below the eyes due to nasal obstruction causing secondary vein stasisAllergic creaseHorizontal line at the lower third dorsum nasi caused by repeted rubFacies adenoidMouth open with high arch palate → disrupted teeth growthCobblestone appearance at posterior pharyngeal wallGeographic tongue
10Malignant otitis externa (necrotizing OE) Elderly diabetics or immunocompromised.OE → cellulitis, chondritis, osteitis, osteomyelitis → cranial neuropathies.The canal may be swollen & tender, red granulation tissue is seen posteroinferiorly at the junction of cartilage with bone, one-third inward.Itch rapidly followed by pain, secrete, & swelling of canal ear.Th/: topical & systemic antibiotics & aggressive debridement
13Sore Throat Acute tonsillitis: Chronic tonsillitis Viral: similar with acute rhinits + sore throatBacterial: GABHS, pneumococcus, S. viridan, S. pyogenes.Detritus → follicular tonsillititsDetritus coalesce → lacunar tonsillitis.Sore throat, odinophagia, fever, malaise, otalgia.Th: penicillin or erythromicinChronic tonsillitisPersistent sore throat, anorexia, dysphagia, & pharyngotonsillar erythemaLymphoid tissue is replaced by scar → widened crypt, filled by detritus.Foul breath, throat felt dry.
14Audiologic Testing in Pediatric • Behavioral observation audiometry – Behavioral reflex audiometry: to observe reflex evoked by sound → eye widening, grimacing, auropalpebral reflex, moro reflex, cessation reflex. – Behavioral response audiometry (5-6 month) → to evoke spesific response: moving head toward sound. • Play audiometry (2-5 year) – a kid is trained to do spesific task (games) when hearing sound stimulus. • Brainstem evoked response audiometry: – BERA is a series of scalp-recorded electrical potentials generated in the auditory nerve and brainstem during the first 10 to 20 ms after the onset of a transient stimulus. – Can be used in infant, children, adults, & comatose patient.
15• Tympanometry: – To assess middle air condition by placing probe tone in ear canal to sense the pressure based on the sound energy reflected from middle ear. • Otoacoustic emission: – objective, noninvasive, and rapid measures used to determine cochlear outer hair cell function. – Evoked OAE are acoustic signals generated by the cochlea in response to auditory stimulation. • Pure tone audiometry: – The audiogram is a graph that depicts threshold as a function of frequency. Threshold is defined as the softest intensity level that a pure tone (single frequency) can be detected 50% of the time.
16Epistaksis• Anterior epistaxis: – Bleeding arises from kisselbach plexus or a. ethmoidalis anterior – it may be precipitated by infection or minor trauma & easy to stop. – Direct digital pressure for 10-15’ on the lower nose compresses the vessel on the septum & will arrest the bleeding. – If bleeding source is seen cauterise with AgNO3. – If it’s still bleeding apply anterior tampon for 2 x 24 hours.
17• Posterior epistaxis – Bleeding arises from a • Posterior epistaxis – Bleeding arises from a. ethmoidalis posterior or a.Sphenopalatina and often difficult to stop – affect patient with hypertension or arteriosclerosis. – Therapy: apply bellocq/posterior tampon for 2-3days.
18Mastoiditis• Acute mastoiditis – the result of extension of acute otitis media into the mastoid air cells with suppuration & bone necrosis. • Symptoms: – Pain, otorrhoea (usually creamy & profuse), increasing deafness. • Signs: – fever, tenderness over mastoid antrum , swelling in the postauricular region, pinna is pushed down & forward, the tympanic membrane is either perforated and the ear discharging, or it is red and bulging. • Investigation: CT scanning shows opacity & air cell coalescence. • Treatment: – Antibiotics IV. If the organism is not known and there is no pus to culture, start amoxycillin & metronidazole immediately. – Cortical mastoidectomy. If there is a subperiosteal abscess or if the response to antibiotics is not rapid and complete, cortical mastoidectomy must be performed.