Ebook Ghai essential pediatrics (8/E): Part 2
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Ebook Ghai essential pediatrics (8/E): Part 2
Otolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection. Ebook Ghai essential pediatrics (8/E): Part 2 Anatomic features that make young children particularly susceptible to ear infections include shorter, more horizontal and compliant eustachian tubes and bacterial carriage in the adenoids. Other risk factors include exposure to ciga ret te smoke, overcrowding, bot t lefeed i ng, cleft palate, Down Ebook Ghai essential pediatrics (8/E): Part 2 syndrome, allergy and immune dysfunction. These risk factors contribute to the pathophysiology of the two common varieties of otitis media, acute otiEbook Ghai essential pediatrics (8/E): Part 2
tis media and otitis media with effusion.Acute Otitis MediaAcute otitis media (AOM) in children tends to have a bĩmodal age distribution, with childreOtolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection. Ebook Ghai essential pediatrics (8/E): Part 2ilus influenzae, accounting for approximately 65% cases; 15% are caused by Moraxella catarrhahs. Streptococcus pyogenes and Sfaphylococcitsauretts. Respiratory viruses play an important role in initiating otitis media and may be the only pathogens in some cases, since 20% of middle ear aspirates are Ebook Ghai essential pediatrics (8/E): Part 2 sterile.Diagnosis. AOM is characterized by the rapid onset of symptoms, which may be local, e.g. otalgia or ear tugging, and/or systemic, e.g. feverEbook Ghai essential pediatrics (8/E): Part 2
or crying. Older children may report impaired hearing. I listory of recent upper respiratory tract infection is common. Otoscopic examination revealsaOtolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection. Ebook Ghai essential pediatrics (8/E): Part 2upture of the drum with ear discharge (suppuration) may have already occurred, in which case the ear canal contains an opaque yellow-green or redd ish-brown fluid. Cleaning of this fluid usually reveals an intact drum, as the ru pt u re is smal I and closes promptly a f t er spontaneous perforation. Ebook Ghai essential pediatrics (8/E): Part 2 The diagnosis of AOM is considered certain if all of the following criteria are met: (i) rapid onset; (ii) signs of middle ear effusion; and (iii) siEbook Ghai essential pediatrics (8/E): Part 2
gns and symptoms of middle ear inflammation.Treatment. Antimicrobial therapy is recommended. However, in some cases children may quali fy for a trial Otolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection. Ebook Ghai essential pediatrics (8/E): Part 2l resistance is endemic. Agents with p-lactamase resistance (e.g. amoxicillin-clavulanic acid, cefaclor, cefuroximeor newer cephalosporins) are useful second-line drugs. InitialTable 13.1: Criteria for choice of treatment or observation in children with acute otitis mediaAxe <6 mo 6-23 mo >24 moDiag Ebook Ghai essential pediatrics (8/E): Part 2nosis certainAntibacterial therapyAntibacterial therapyAntibacterial therapy if illness severe*Observation is an option if illness not severe”DiagnosiEbook Ghai essential pediatrics (8/E): Part 2
s uncertainAntibacterial therapyAntibacterial therapy if illness severe*Observation IS an option if illness not severe”•Severe illness IS defined as mOtolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection. Ebook Ghai essential pediatrics (8/E): Part 2sist or worsenAdapted from guidelines of the American Academy of Pediatrics and American Academy of Family Physicians Clinical Practice Guideline Subcommittee on Management of Acute Otitis Media. Mtatriet 2004:113 1451-65359https://khothuvien.cori!Essential Pediatrics■antibiotic therapy should last Ebook Ghai essential pediatrics (8/E): Part 2at least 7 days. Reexamination is indicated after 3-4 days and at 3 weeks.Adjuvant treatment with oral and topical decongestant drugs is not necessaryEbook Ghai essential pediatrics (8/E): Part 2
. Antihistaminic agents, which contribute little to the resolution of otitis media and may precipitate sinus infections due to their drying effect on Otolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection. Ebook Ghai essential pediatrics (8/E): Part 2ay provide specimen for culture in patients with complicated AOM who cannot tolerate tympanostomy tube insertion. Tympanocentesis improves otalgia but does not shorten the course of the illness.Many children present with recurrent episodes of AOM. A child that has 4 episodes of AOM in 6 months or 6e Ebook Ghai essential pediatrics (8/E): Part 2pisodes in 12 months should be considered for tympanostomy tube insertion. If a child requires a second set of tympanostomy tubes, concurrent adenoideEbook Ghai essential pediatrics (8/E): Part 2
ctomy is considered. No benefit from concurrent tonsillectomy has been demonstrated in patients with recurrent AOM.Otitis Medio With Fftusron (OMF)FolOtolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection. Ebook Ghai essential pediatrics (8/E): Part 2M and in 10% after 3 months. Many children with ỌME do not have a history of previous acute middle ear infections. Most children are asymptomatic or complain of hearing loss and ear fullness.Otalgia is not normally present. Otoscopy reveals a dull tympanic membrane with middle ear effusion (Fig. 13. Ebook Ghai essential pediatrics (8/E): Part 21), frequently with air fluid levels or bubbles. Reducedtympanicmembrane mobility on either pneumatic otoscopy or type B pattern on tympanometry confiEbook Ghai essential pediatrics (8/E): Part 2
rms the diagnosis.Since over 65% of serous middle ear effusions resolve spontaneously within 3 months, newly diagnosed effusions should be observed foOtolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection. Ebook Ghai essential pediatrics (8/E): Part 2osteroid administration has not been proven but a brief trial of steroids is commonly used.If effusion persists beyond 3 months, tympanostomy tube insertion may be considered for any hearing loss >25 dB (Fig. 13.2). Other indications of tube placement in OME are speech delay, altered behavior, major Ebook Ghai essential pediatrics (8/E): Part 2 sequelae such as otitic meningitis or impending cholesteatoma formation from tympanic membrane retraction. Improvement in hearing and ear discomfortEbook Ghai essential pediatrics (8/E): Part 2
is immediate. Mean time beforeextrusion is usuallybetween 12 and 18months. Insertion of longterm tubes (of T-tube design) or adenoidectomy may be consOtolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection. Ebook Ghai essential pediatrics (8/E): Part 2commended while the tubes are in place to avoid entry of water into the middle ear space.Chronic Suppurative otitis Media (CSOM)Ear drainage that persists for longer than 6 weeks is generally due to chronic inflammation of the middle ear space or mastoid air cells. Chronic suppurative otitis media ( Ebook Ghai essential pediatrics (8/E): Part 2CSOM) invariably presents with tympanic membrane perforation, which allows otorrhea. CSOM most often results from neglected episodes of AOM and is theEbook Ghai essential pediatrics (8/E): Part 2
refore more common in children with inadequate access to health care. It most often occurs in the first five years of life as eustachian tube dysfunctOtolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection. Otolaryngology13Sandeep Samant, Grant T. Rohman, Jerome w. ThompsonDISEASES OF THE EAROtitis MediaOtitis media is a common early childhood infection.Gọi ngay
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