Alternative Ways to Treat Otitis
Otitis media is another middle ear condition. It is most common in infants and children, but it may also occur in adults. Usually, it happens after or along with an upper respiratory infection. The condition is bacterial in origin. The two types of otitis media are serous otitis media and purulent otitis media. b. Serous Otitis Media (SOM). This condition is not caused by an infection. The infection is in the pharynx at the eustachian tube. Clear amber fluid with air bubbles has built up behind the tympanic membrane (TM). c. Purulent Otitis Media (POM). POM occurs after an upper respiratory infection or bacterial (strep) pharyngitis. A yellowish-brown purulent fluid builds up behind the tympanic membrane. d. Signs Symptoms of Otitis Media. Included are the following e. Treatment. Bedrest and analgesics such as aspirin are parts of the treatment for otitis media. Penicillin or broad-spectrum antibiotics continued for 7 to 10 days will help to prevent the recurrence of...
An 18monthold has failure to thrive and developmental delay The patient also has a history of recurrent ear infections
In the majority of infants the physical examination at birth is normal. However, over a period of time the infant may develop failure to thrive. Problems such as lymphoid interstitial pneumonia, chronic otitis media, persistent diarrhea, hepatosplenomegaly, recurrent bacterial sepsis, and candidiasis may be seen. Older children have physical findings similar to adults. Definition of Abbreviations AIDS acquired immunodeficiency virus CMV cytomegalovirus CT computed tomography HSV herpes simplex virus LIP lymphoid interstitial pneumonia MRI magnetic resonance imaging OFC occipitofrontal circumference OM otitis media PCR polymerase chain reaction. Modified from Centers for Disease Control and Prevention MMWR 43(RR-12) 1-19, 1994.
Ear infections are common in small children. The infection often begins after a few days with a cold or a stuffy or plugged nose. The fever may rise, and the child often cries or rubs the side of his head. Sometimes pus can be seen in the ear. In small children an ear infection sometimes causes vomiting or diarrhea. So when a child has diarrhea and fever be sure to check his ears. It is important to treat ear infections early. Give an antibiotic like penicillin (p. 351) or co-trimoxazole (p. 358). In children under 3 years of age, ampicillin (p. 353) often works better. Give acetaminophen (p. 380) for pain. Aspirin also works but is less safe (see p. 379). Do not bottle feed babies or if you do, do not let a baby feed lying on his back, as the milk can go up his nose and lead to an ear infection.
External otitis varies in severity from a mild dermatitis to cellulitis or even furunculosis of the ear canal. This ear problem is often referred to as a fungal infection of the ear. In many cases, the problem is not an infection but dermatitis caused by contact with earphones or earrings. b. Signs Symptoms. Pain, itching, dry scaling ear canal, and watery or purulent discharge are the chief signs symptoms of external otitis. Fever may be present if the infection is severe. Other signs and symptoms are erythema, edema, and pustule formation.
A 4yearold child is seen in the office with a 3day history of fever and cold symptoms and now complains of right ear
Otitis media (OM) is inflammation of the middle ear. Risk Factors Etiology. Infants and children are at highest risk for otitis media, with the risk decreasing after 6 years of age. Male sex, daycare settings, secondhand smoke, and formula feeding predispose to OM. Craniofacial anatomy and eustachian tube dysfunction are responsible for development of OM. Patients with craniofacial anomalies are also at increased risk for OM. Streptococcus pneumoniae, nontypable Haemophilus influenzae, and Moraxella (Branhamella) catarrhalis are the most common bacterial causes of OM. Viruses (respiratory syncytial virus, rhinovirus, influenza, adenovirus) can also cause OM, alone or as copathogens with bacteria. Treatment. Treatment consists of oral antibiotics. Amoxicillin is still the drug of choice for uncomplicated acute otitis media. Otalgia or fever persisting after 72 h of therapy should be considered a treatment failure, and a change in antibiotics is indicated, usually to...
Discussion Otitis media is the most common pediatric bacterial infection and is caused by Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae in neonates in older children it is usually caused by pneumococcus (Streptococcus pneumoniae), H. influenzae, Moraxella catarrhal)s, and group A streptococcus. Resistant strains are becoming increasingly common.
The staphylococci (figure 3-2) are ubiquitous in nature. They occur as normal inhabitants on the skin and in the respiratory and gastrointestinal tracts of man. The majority of such forms are the comparatively avirulent organisms. Staphylococcus epidermidis and the related forms of Micrococcus and Sarcina are saprophytes frequently isolated from the skin and mucous membranes. Staphylococcus aureus strains are usually responsible for the staphylococcal diseases of man. These forms occur especially in the upper respiratory tract of asymptomatic individuals. The asymptomatic carrier is of considerable importance in transmitting these organisms. Staphylococcal diseases are most commonly manifested in localized suppurations that may be in the form of simple pustules, hair follicle infections, boils, or extensive carbuncular conditions that may progress to form metastatic abscesses in any tissue. The latter results from the spread of the organism via the blood...
Pneumococcal disease was the first infection to be prevented by a nonprotein vaccine. Due to the work of Griffith, Tillet, Finland, Heidelberger, MacLeod, and Austrian, the capsular polysaccharide has come to be recognized as a critical component of vaccine efficacy (reviewed in Musher and associates109 and Broome and Breiman110). The geographic distribution of serotypes differs by region, making a universal vaccine based on a reasonable number of capsular types complicated and costly to compose.111 The currently approved vaccines consist of the capsular polysaccharides from 23 of the most common serotypes.110 After many comprehensive studies, there is now overwhelming evidence that this vaccine is approximately 60 efficacious for protection against invasive disease in the general population, but it fails to protect the segments of the population most susceptible to disease children younger than the age of 2 years or the elderly who are medically compro-mised.110,112-114 The vaccine...
The cause of this condition is usually trauma but occasionally the problem is caused by acute otitis media. c. Treatment. Treatment should not include medications in the ear or any packing of the ear. Keep the ear dry and clean. An external dressing is recommended. Oral analgesia is not usually needed. The patient should be restricted from flying, swimming, or heavy contact with loud noises. Keep water out of the ear. Systemic antibiotics should be given only if infections occur. Evacuation is not urgent unless a flap is present. If there is only a small perforation, called a pinhole, no treatment is necessary. Some complications of this condition are the failure to heal spontaneously, ear infection, and scarring.
PE Vesicular rash over left pinna (otitis externa) left-sided lower motor neuron-type facial nerve palsy (patient is unable to frown and unable to blink left eye eyeballs roll up during attempt to close eye patient is unable to whisde taste sensation over anterior two-thirds of tongue lost on left side).
The encapsulated strain of H. influenza may cause pharyngitis, conjunctivitis, otitis, sinusitis, pneumonitis, or meningitis. Meningitis is rare, occurring primarily in children under three years of age. The nonencapsulated variety of H. influenzae is considered to be normal flora in the upper respiratory tract of adults. Haemophilus influenzae is a fastidious organism and requires a medium enriched with blood or hemoglobin to supply the X factor and also a supplement for the V factor. All strains of H. influenzae reduce nitrates and are soluble in sodium deoxycholate indole is produced by the encapsulated strains and fermentation reactions are variable. In cases of suspected meningitis caused by H. influenzae, spinal fluid is submitted. The specimen should be centrifuged and the supernatant disposed of in accordance with local laboratory procedures. The sediment is inoculated on a blood agar and a chocolate agar plate to which supplement has been added, or...
ID CC A 10-year-old boy is brought to the pediatrician complaining of high fever, sore throat, earache, swollen glands, and productive, greenish-white, blood-tinged sputum. nasopharyngeal isthmus) tonsils markedly enlarged, hyperemic, and cryptic with spotted areas of pus inflammation of torus tubarius (protects opening of eustachian tube auditory meatus is immediately anterior and inferior to pharyngeal tonsil, and infection of pharyngeal tonsils spreads up auditory tube, causing otitis media).
Group A beta-hemolytic streptococci are nonmotile bacteria that can occur in pairs or chains. These bacteria are responsible for a variety of diseases ranging from streptococcal sore throat to scarlet fever. Impetigo, pyoderma, otitis media, wound infections, and rheumatic fever are also associated with group A beta-hemolytic streptococci. Acute infections are best diagnosed by direct streptococcal cultures.
A 4-year-old boy is brought to the emergency room complaining of left ear pain that awakened him from sleep. The child has no past medical history and has been in good health. During the physical examination, the child is irritable and often tugs at his left ear. His temperature is 101.5 F and he has no lymphadenopathy. The left tympanic membrane is bulging and erythematous. Which of the following is the most likely diagnosis b. Serous otitis media c. Acute otitis media
A stuffy or runny nose can result from a cold or allergy (see next page). A lot of mucus in the nose may cause ear infections in children or sinus problems in adults. 4. Wipe a runny or stuffy nose, but try not to blow it. Blowing the nose may lead to earache and sinus infections. 5. Persons who often get earaches or sinus trouble after a cold can help prevent these problems by using decongestant nose drops like phenylephrine (p. 384). Or make nose drops of ephedrine tablets (see p. 385). After sniffing a little salt water, put the drops in the nose like this
A 3-year-old has had repeated episodes of sinusitis and otitis media. He was recently admitted for osteomyelitis of his femur with Staphylococcus aureus. The family notes that while his first four or five months of life were normal, he has been persistently ill with multiple infections in the ensuing months. The mother notes that her brother had similar problems with infections and died at the age of 3 years from a lung infection. Physical examination is significant for the absence of lymph nodes and tonsillar tissue. (SELECT 1 TEST)
Upper respiratory infections (URI), or the common cold, are caused by rhinoviruses, parainfluenza viruses, respiratory syncytial viruses, and coronaviruses. Children are the major reservoirs. The incubation period is 2-5 days. Transmission is by large droplets, small aerosol particles, or secretions. Symptoms include fever, nasal congestion, rhinorrhea, sneezing, pharyngitis, and malaise. Most symptoms resolve by 5-7 days. Treatment is not necessary. Complications include otitis media, sinusitis, and pneumonia.
This disease is caused by Chlamydia trachomatis, an obligatory intracellular bacterium. It is the most common bacterial STD in women, occurring up to five times more frequently than gonorrhea. The long-term sequelae arise from pelvic adhesions, causing chronic pain and infertility. When the active infection ascends to the upper genital tract and becomes symptomatic, it is known as acute pelvic inflammatory disease (acute PID). Transmission from an infected gravida to her newborn may take place at delivery, causing conjunctivitis and otitis media.
A 2-year-old boy presents to the physician's office for an ear check. The child had an ear infection that was treated with trimethaprim-sulfamethoxazole 3 weeks earlier. On physical examination the patient is noted to be extremely pale. Hb and Hct were obtained and are noted to be 7.0 g dl and 22 , respectively.
A 2-year-old is admitted with fever, cough, and bilateral earache. On examination, the child is tachypneic with suprasternal and intercostal retractions and nasal flaring, which requires immediate ventilatory support. Lung exam reveals bilateral wheezing and inspiratory crackles. White blood count and differential are normal. CXR is shown in Fig. 83.
Independent type 1 and type 2 bacterial antigens and to protein T-dependent antigens (see Table 7.9 for summary). The type 2 antigens were capsular polysac-charides from Streptococcus pneumoniae, type III and Neisseria meningitidis, serotype C. The former causes meningitis and otitis media as well as pneumonia in humans, while the latter causes meningitis. The type 1 antigens were lipopolysaccharides from Pseudomonas aeruginosa, an opportunistic pathogen associated with respiratory and ocular infections, and from Ser-ratia marcescens. The T-dependent protein antigens were tetanus toxoid and sheep red blood cells. Young growing male rats raised on vitamin A-deficient or sufficient diets were immunized either near 40 days of age, before signs of vitamin A deficiency were apparent, or near 47 days when symptoms of deficiency were beginning to manifest. The results showed that asymptomatic vitamin A-deprived rats, immunized when they were still growing, had a markedly reduced specific...
An 8-month-old male infant is admitted to the hospital because of a bacterial respiratory infection. The infant responds to appropriate antibiotic therapy, but is readmitted several weeks later because of severe otitis media. Over the next several months, the infant is admitted to the hospital multiple times for recurrent bacterial infections. Workup reveals extremely low serum antibody levels. The infant has no previous history of viral or fungal infections. The most likely diagnosis for this infant is
The answer is a. (Fauci, 13 e, p 518.) Ear pain and drainage in an elderly diabetic patient must raise concern about malignant external otitis. The swelling and inflammation of the external auditory meatus strongly suggests this diagnosis. This infection usually occurs in older diabetics and is almost always caused by Pseudomonas aeruginosa. Haemophilus influenzae and Moraxella catarrhalis frequently cause otitis media but not external otitis.
This is a very serious infection of the brain, more common in children. It may begin as a complication of another illness, such as measles, mumps, whooping cough, or an ear infection. Children of mothers who have tuberculosis sometimes get tubercular meningitis in the first few months of life.
Vomiting is one of the signs of many different problems, some minor and some quite serious, so it is important to examine the person carefully. Vomiting often comes from a problem in the stomach or guts, such as an infection (see diarrhea, p. 153), poisoning from spoiled food (p. 135), or 'acute abdomen' (for example, appendicitis or something blocking the gut, p. 94). Also, almost any sickness with high fever or severe pain may cause vomiting, especially malaria (p. 186), hepatitis (p. 172), tonsillitis (p. 309), earache (p. 309), meningitis (p. 185), urinary infection (p. 234), gallbladder pain (p. 329) or migraine headache (p. 162)
Human breast milk is the preferred food for full-term babies. It offers several advantages to both mother and infant. Breast milk is premixed at the right temperature and concentration. Breast milk has immunologic factors such as IgA, lactoglobulin, and maternal macrophages, which protect the infant from infections. Breast-fecfbabies have a lower incidence of upper respiratory tract infections and otitis media than their formula-fed counterparts. Breast milk also decreases the incidence of allergic diseases. Maternal advantages to breast feeding include a more rapid return to prepregnancy weight and faster uterine regression. Breast feeding also promotes maternal-infant bonding.
A 12-month-old infant presents to the physician with the chief complaint of refusing to bear weight on his left lower extremity. The mother states that the child had an ear infection 1 week ago. The patient was prescribed antibiotics, but the mother states she did not fill the prescription.