HY: head & neck infections
meduploader - 05-06-09 05:48

Otitis Externa
By Pseudominas, typically in swimmer's.
Hallmark is pain on traction of pinna. Difficult to visualize external ear canal due to swelling.
No diagnostic test. Don’t perform culture of ear canal.
Tx is systemic ciprofloxacine is the most appropriate initial therapy. Topical hydrocortisone to decrease swelling.

Malignant OE (OM of skull)
It is seen in DM and immunocompromised pt, malodor green discharge, granulation,
Treat it like OM: X- ray, MRI, bone biopsy/culture.
Best initial test: skull X- ray or MRI
Tx is in-hospital admin of parenteral Ciprofloxacine and possible surgical debridement.
Fungal ones have white fibers in canal and Bacterial ones have nothing.

Otitis Media :
Strep. Pneumoniae (35-40 %) , H. influenzae (25-30%),Moraxella(15-20%)
Earache, fever, decrease hearing, red, bulging tympanic membrane with loss of light reflex, immobility of the membrane on insufflations of the ear with air
Amoxicillin (Best initial therapy) / Amoxicillin + clavulanate (if recent use of Amoxicillin)
Azithromycin / newer fluoroquinolone (Alternatives)
Best next step  perform the most accurate test tymapnocentesis and and aspirate of the tympanic membrane for cultures. Rarely necessary and only done for recurrent or persistent cases that fail therapy.
Complications : Acute mastoditis [pinna displaced inferior & laterally – X-ray of skull, mastoid – IV antibiotics + surgical debridement (mastodectomy may require)] Middle ear effusion (follow up after 4-6 wks; If not resolved, tympanostomy may require; referral to ENT]
Chronic OM: presents as purulent discharge. Tympanic membrane appears thicker with calcific patches but there is no exudation of debris or granulation tissue.
Serous OM: results due to prolonged blockage. The tympanic membrane is dull and hypo
mobile. Air bubbles are seen in the middle ear. Have conductive hearing loss.

Sinusitis :
Headache ( worse on leaning forward),facial pain, nasal discharge.
It’s a clinical Dx, so if asked best next step in management  Rx
DX: Maxillary sinus x-ray ( best initial test )
Most accurate  sinus aspirate for culture. This is more accurate than a CT (you cant culture a radiologic test)
Uncomplicated  decongestant , Analgesic
Complicate d (discolored nasal discharge)  Antibiotics
Dx in children
• If symptoms within first 30- 36 hr : Zanamivir, Oseltamivir (neuraminidase inhibitors)
• If within 48 hr : Amantadine, Rimantadine
• If beyond this : Symptomatic therapy with acetaminophen (Tylenol)
Zanamivir:
• Nasal & throat irritation (inhalation)
• Exacerbate asthma (via bronchospasm)
• Nausea, vomiting (most common)
Amantadine:
• Livedo reticularis
• CNS: nervousness, insomnia, seizures
• Atropine like peripheral effects
Neuraminidase inhibitors:
Approved by the United States FDA for the treatment of influenza in
- adults
- Children > 7 years for zanamivir and
- Children > 1 year for oseltamivir
Oseltamivir has also been approved for prophylaxis in
- Adults and
- Adolescents > 13 years