12 – Ear, Nose and Oropharynx
Tx in over 3 year olds = anaesthetic ear drops
Chapter 12 – Ear, Nose plus oral analgesics
and Oropharynx Indications for ABs = systematically unwell,
high risk of complications, cystic fibrosis,
OTITIS EXTERNA immunosuppression, children < 2 years with
bilateral otitis media or otorrhoea
Inflammatory reaction of meatal skin
Otitis media with effusion (‘glue ear’)
Effective method = introduce a ribbon gauze
Occurs in 10% of children and in 90% of
dressing or sponge wick soaked with
children with cleft palates
corticosteroid ear drops or within an astringent
If it persists for > 1 month, refer child
like aluminium acetate solution.
Chronic OM
If infected:
Cleanse with aural micro-suction
Topical neomycin or clioquinol for < 7 days
Consider antibacterial ear ointment
(excess use = fungal infection)
Amoxicillin – used for acute exacerbations
Aluminium acetate
of chronic infection
Chloramphenicol - propylene glycol may
cause hypersensitivity in 10% Pts Removal of ear wax
AVOID aminoglycosides or polymyxins if Softeners = olive or almond oil ear drops
perforated tympanic membrane (eardrum) Sodium bicarbonate ear drops – effective
or patent grommet. If used by specialists: but may cause dryness of ear canal
o Use only in obvious infection If wax is hard and impacted = used BD for
o Tx should be for a max 2 weeks several days. Lie with the affected ear
o Counsel on ototoxicity risk uppermost for 5-10 mins
o Commence baseline audiometry Docusate and urea hydrogen peroxide are
Acetic acid 2% (‘EarCalm’) - antifungal and used to soften ear wax
antibacterial activity in external ear canal Irrigation (water) – used to remove wax
Flucloxacillin – used for resistant staph
Avoid irrigation in:
infection (boil) in ear drum
- Young children
OTITIS MEDIA - Pts unable to cooperate with procedure
- Pts with otitis media in last 6 weeks
Acute - Otitis externa or previous ear surgery
Characterised by inflammation in the - H/O ear drum perforation
middle ear associated with effusion = rapid
NOSE
onset of symptoms of ear infection
Causes = viruses or bacteria (or both) Seasonal allergic rhinitis (hayfever) – start Tx
Symptoms = ear pain, poor feeding, approx. 2-3 weeks before season starts
irritability, fever, crying, restlessness at
Corticosteroids – avoid in untreated nasal
night, cough or rhinorrhoea – usually
resolve in 3-7 days without ABs infections, after nasal surgery and in pulmonary
TB. Risk of systemic SEs is higher with nasal
Complications = mastoiditis, meningitis,
intracranial abscess, sinus thrombosis and drops compared to sprays
facial nerve paralysis
Tx in over 3 year olds = anaesthetic ear drops
Chapter 12 – Ear, Nose plus oral analgesics
and Oropharynx Indications for ABs = systematically unwell,
high risk of complications, cystic fibrosis,
OTITIS EXTERNA immunosuppression, children < 2 years with
bilateral otitis media or otorrhoea
Inflammatory reaction of meatal skin
Otitis media with effusion (‘glue ear’)
Effective method = introduce a ribbon gauze
Occurs in 10% of children and in 90% of
dressing or sponge wick soaked with
children with cleft palates
corticosteroid ear drops or within an astringent
If it persists for > 1 month, refer child
like aluminium acetate solution.
Chronic OM
If infected:
Cleanse with aural micro-suction
Topical neomycin or clioquinol for < 7 days
Consider antibacterial ear ointment
(excess use = fungal infection)
Amoxicillin – used for acute exacerbations
Aluminium acetate
of chronic infection
Chloramphenicol - propylene glycol may
cause hypersensitivity in 10% Pts Removal of ear wax
AVOID aminoglycosides or polymyxins if Softeners = olive or almond oil ear drops
perforated tympanic membrane (eardrum) Sodium bicarbonate ear drops – effective
or patent grommet. If used by specialists: but may cause dryness of ear canal
o Use only in obvious infection If wax is hard and impacted = used BD for
o Tx should be for a max 2 weeks several days. Lie with the affected ear
o Counsel on ototoxicity risk uppermost for 5-10 mins
o Commence baseline audiometry Docusate and urea hydrogen peroxide are
Acetic acid 2% (‘EarCalm’) - antifungal and used to soften ear wax
antibacterial activity in external ear canal Irrigation (water) – used to remove wax
Flucloxacillin – used for resistant staph
Avoid irrigation in:
infection (boil) in ear drum
- Young children
OTITIS MEDIA - Pts unable to cooperate with procedure
- Pts with otitis media in last 6 weeks
Acute - Otitis externa or previous ear surgery
Characterised by inflammation in the - H/O ear drum perforation
middle ear associated with effusion = rapid
NOSE
onset of symptoms of ear infection
Causes = viruses or bacteria (or both) Seasonal allergic rhinitis (hayfever) – start Tx
Symptoms = ear pain, poor feeding, approx. 2-3 weeks before season starts
irritability, fever, crying, restlessness at
Corticosteroids – avoid in untreated nasal
night, cough or rhinorrhoea – usually
resolve in 3-7 days without ABs infections, after nasal surgery and in pulmonary
TB. Risk of systemic SEs is higher with nasal
Complications = mastoiditis, meningitis,
intracranial abscess, sinus thrombosis and drops compared to sprays
facial nerve paralysis
