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Chapter 2 Index
A. Evaluation by system:
1. General 2. HEENT
--Otitis Media:
Classification, Rx and Complications
--Pediatric ENT:
1. When to Refer for Tubes
2. Laryngeal Abnormalities |
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The Treatment of Otorrhea
Drs. Schwartz and Bahadori - Contemporary Peds, May 1999
Introduction: Otorrhea is common in the pediatric age
group. It can be acute (lasts less than three weeks), subacute (three to
six weeks), and chronic (more than six weeks).
Acute Otorrhea: Most have draining from tubes (70%), the
rest from draining acute otitis media, or external otitis. Many children
make recurrent visits for this complaint.
- Tubes: The reported incidence of otorrhea from tubes is between 15%
and 50% average is about 20% of children will get drainage through their
tubes.
- Time likely to get drainage is after surgery (accumulated infected
draining liberated by draining through the tubes); about 8% of children
with tubes will have drainage in the first 10 days after surgery.
Prevention: instill antibiotic drops at time of surgery.
- Swimming or presence of water in the ear produces otorrhea. Diving
two or more feet below the surface may increase the incidence of
otorrhea.
- Acute otitis media: With antibiotic therapy, perforation heals within
48 hours. Infection with Strep Pyogenes is associated with the most
complications if not treated adequately. Most common organisms are H.
Influenzae, Strep pyogenes, pneumococcus.
- Otitis Externa: very common; Pseudomonas the major offending organism.
- Others: draining pustule, furuncle, ruptured blister from impetigo,
poison ivy. Crystal clear drainage can be caused by a CSF leak (produces
a positive glucose oxidase paper test can make this diagnosis as can
testing fluid for Beta 2 transferrin.)
Treatment of Acute Otorrhea:
- Tubes: Pediatricians: oral antibiotics; ENT: suction frequently, otic
drops. If granulation tissue is present around the tube, must keep the
tube dry and suction it. Recent evidence that ENT have been correct: only
need Floxin drops.
- Acute otitis media without tubes: drops may replace oral treatment.
The limiting factor is the size of the perforation - it needs to be large
enough to permit the drops to get through the eardrum.
- Otitis Externa: some ENT recommend gentle but thorough suction or
lavage of the ear canal. This would be quite painful and might not be
accepted. Also use antibiotic drops.
Chronic Otorrhea - Many causes of chronic otorrhea (more
common in Native Americans):
- Granuloma around tube or in middle ear; foreign body in middle ear;
cholesteotoma in middle ear; immune deficiency; middle ear tumor;
wegener’s granulomatosis; tb or fungal infection of otomastoid space.
Treatment of Chronic Otorrhea:
Pediatricians: oral antibiotics; 80% also use topical antibiotics;
if fail, switch meds, then refer
ENT: suction frequently (3X/wk); use drops; a few use antibiotics.
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