#staph ear infection

[lesbianbassline]

i found out i have the url "staphylococcusaureus" saved. i have no memory of doing this.

[st5lker]

funniest possible timeline is if this WAS staged but the grazing of his ear he was willing to take to secure the election results in a staph infection and he dies anyway

[xxcocothekillerxx]

Behind Locked Doors

Pairing: Johnny Slaughter x FemReader

Summary: Y/N recently moved into a somewhat small town, Newt, In Texas with her father. Y/N's father thought this would be a good opportunity for them, since things got rough back in California. Little do they know the trouble that awaited them..

!THIS CHAPTER DOESN'T CONTAIN NSFW!

Warning: This series will contain 18+ content & material! NSFW situations and possibly TRIGGERING topics such as- Depression, stalking, blood & gore, manipulation, mention of kidnapping and small amounts of self-harm, such as scars/cuts.

{{ Please proceed with care if you're sensitive to ANY of these topics }}

Author's Note: This is my first time really writing NSFW stories / stories in general. Tips and tricks on how to improve my writing and overall layout are welcome, though keep it respectful please. Other than that please enjoy! 💋

💋Chapter 1: A new town💋

It's been over a week now since you and your father have moved to this small town. The feeling of warm, hot and heavy, air and slight stench of garbage filled your nose as you were cleaning and fixing up your room.

The house you and your father picked was interesting, to say the least. Its dull, gray and moldy wallpaper lined most of the walls around the house. Holes and cracks littered the corners of the old building, the windows barely holding up against the breeze that hit them from the outside. The rusty door knobs, simply waiting to give a poor unexpecting victim a staph infection, and the doors themselves are ready to fall off their hinges.

Although your father had fixed up the downstairs area pretty well, painting the walls in a faded out, pastel yellow. Re-painting the door to their original bright white, and fixing up the hinges so they wouldn't fall off. He also bought new kitchenWare, the stove and fridge were nearly brand new and he insisted they were 'fresh out of the factory'. A beautiful dark brown wood table, with matching chairs, sat in between the kitchen and the living room. A pot of lavender and pink poppies in a little white vase, with a sage green cloth underneath it, laid in the middle of the table. Family pictures hanging on parts of the walls, leading over to the living room where a shag carpet and old leather couch sat with those old style TVs.

Your room had (color) wallpaper, with old CDs and photos hung on the walls. You had a nice window and strung a spider plant about it, pinning some of its vines to the side with some books and some toys sitting on the window sill. Your bed was a decent size, enough to hold two people comfortably, and had soft and cozy (color) sheets. The wooden floor was covered with a shag rug, and large plants sat by your doorway and against your bookshelf. You were just finishing up cleaning up and lighting a candle when your father knocked on your door, slightly catching you off guard because you had music playing on your old radio, you quickly turned your music off and opened the bedroom door.

Your father stood there, he slightly adjusted his almost cartoonishly large glasses and then gave a gentle smile. "Hey sweetie.. sorry I don't mean to bother ya' , I just wanted to know if you wanted to come shopping with me real quick?" He joyfully explained, his goofy smile nearly going ear to ear as he looked at you.

"Uh…sure why not" a small smile appears on your face and you gently put down your headphones onto your desk, brushing your (color), hair back behind your ears. You really haven't been out much this week, and it could do you some good to get out for awhile. Your father gives an almost triumphant look as he quickly turns to walk down the hallway, his footsteps getting quieter as he gets further away.

You walked over to your dresser picking out a simple outfit, a teal color tie dye T-shirt, tied at the waist to give a crop top feel and bell-bottom jeans with little colorful flowers near the bottom of the legs and on the back pockets. You then put your white shoes on and headed downstairs to meet up with your father, grabbing some hair ties on the way out and putting them on your wrist before shutting the door behind you. Your father was waiting at the table while looking at a newspaper, his large glasses slightly tilted downwards as he read. His gaze lifted as he heard your footsteps, a gentle and warm smile appearing on his face as he got up from the table.

"Ready?" He says, keys in hand as he tilts his head slightly towards the door. You nod in response, walking towards the door as your father opened it for you. Walking down the steps of the porch, a warm and comforting breeze hits your face. The fresh air quickly running up your nose, a sense of relief from being so cooped up all week makes you feel good and refreshed. The bright blue sky and the sun, only covered lightly with scattered puffy clouds and chirping birds. You take in your surroundings for a brief moment. The sounds of the wind and birds filling your ears as your father walks past you towards the car, his bright striped shirt regaining your attention as you walk to catch up to him, making your way to the passenger side door and opening it. Your father started up the old, Cherry red, 1973 Pontiac Astre. The engine rumbles to life as your father rolls his window down to place his arm on the door, he adjusts the radio to his favorite channel and some new station comes on.

A man starts to speak through the light static “The search continues in Muerto County for a missing University of Texas student. The Sheriff’s department says that Maria Flores, a native of Uvalde, was last seen near the town of Newt more than two months ago. Her vehicle was recently discovered abandoned along Country Road 172, with officials reporting no signs of foul play. Authorities are hopeful that the expanded search into the nearby communities of Harlow and Chinatown will unearth new leads. Family and friends are urging anyone with information regarding her disappearance to please come forward.” The man then proceeded to introduce the forecast of the week and then quickly cut to a popular music station playing 'Can't get enough - Bad company'. You and your father give a concerned glance towards each other before your father starts to drive out onto the road. The wind blowing through your hair, the comforting breeze making you close your eyes and enjoy the ride. Aside from a few random roadkill on the road, the music played loudly in your ears as you slightly danced to yourself as your father jammed to the song and you enjoyed the car ride into town.

Soon you and your father enter the town. Your eyes couldn't help but look around, an old gas station and mechanic shop sat on the right side with some small buildings and stores littered behind them, a few apartment buildings and roller rink sat on the left side with a large school and church sat behind them. You took in the view, not many people were walking around except for a group of teenagers and some adults, some with their little ones, you then noticed the missing person posters scattered on the telephone poles. 'Must be that poor girl from the news station they mentioned' you thought, a sense of sadness slightly washed over you as you felt bad for her family and friends. Your eyes soon wandered over to an older gentleman, he was smiling as a few older lady's. He wore a yellow button up with a blue and red plaid coat, a yellow hat covered his brown hair that clearly was receding and was graying. He had a cane in his hand that he was slightly leaning against as he was, somewhat in a creepy way, talking to the two old ladies. His smile reminds you of a beaver as he talks, however you notice his gaze quickly rising to your car as you drive by, his smile quickly disappears as his locked eyes with you. You quickly felt yourself look away and down at your lap, you felt embarrassed for staring and quickly looked over to your father who was simply paying attention to the road while trying to find a parking spot.

As your father parked the car, he looked over and noticed your uneasiness. "Y/N? You alright?.." he opened the card or on his side, yet waited for your response and sat there. "Y-yea.. sorry" you chuckled, trying to push off the fact you stared at a random old man and got creeped out. Your father nodded and got out of the car, quickly meeting you on the other side as you got out yourself. "Well, I need to grab a few things from the general store and then the post office. Why don'tcha you go take a good look around town… I might be while so." Your father explained, and a big smile on his face and he gently patted your shoulder. You simply nodded as your father walked away to the general store, your eyes quickly wandered over to a clothing store and its bright luring colors. You started to walk down the sidewalk, humming to yourself when you take notice of the same old man you saw before, now sitting on a bench reading a newspaper, except you can't help but notice him side eyeing you from behind the newspaper. You felt a knot in your throat as you started to get close to him, he was sitting next to the store you wanted to go in. You have no clue why he was giving you the creeps, however you swallow your fear and give a warm smile towards the old man.

This seemed to slightly catch him off guard however and nearly made him shove his face into the newspaper, starting to grumble things underneath his breath.

"H-hello sir!" You slightly felt your heart race as the man raised an eyebrow and slowly looked towards you, his dark eyes giving a questionable look as if he was wondering why you're trying to talk to him. However he quickly snaps a smile at you and puts his newspaper down on the bench as he reaches his hand out for a shake. "Nice to meetcha lil' lady.. new around here?" His voice semi cracked as he spoke, you could hear a slight lisp too. "Yes I am.. My name is Y/N!, my father is also here with me.. he's just grabbing a few things" you nervously stated, you quickly shake his hand before politely cupping them together in front of you. The old man nodded as if he understood and or cared before standing up and giving that creepy beaver smile towards you. "Names Drayton, Drayton Sawyer.. My family lives in this town. Though most em ain't the social type…except that boy Johnny." He gave an annoyed look as he rambled, quickly stopping before giving an almost serious look towards you. "Welcome to the town.." he said, his eyes almost dark as he spoke. He then tipped his hat before walking away, you watched as he almost waddled away and then disappeared behind some buildings.

You calmed yourself down slightly before walking into the clothing store, a nice old lady behind the counter gave you a warm and welcoming smile. "Hello dear! Welcome.." she said, her gray hair in a bun behind her head, her sun kissed skin covered with wrinkles. She wore a pretty blue blouse with a blue floral skirt that hit her ankles and her dark blue flats, she adjusted her glasses to better see you as you walked in. You nodded as you looked around the shop at all the cute and somewhat old fashioned clothes, soon you hear three girls walk into the store. A red head wearing a pink plaid button that was tied up slightly above the waist and jean shorts, a dark Brunette with tanner skin wearing and baby blue blouse with a white floral pattern on the chest and tan bell-bottoms, and a dark Brunette wearing a red tank-top with a deep v-neck and yellow sunflower on it and blue jean bell-bottoms. The girls were talking and somewhat giggling to themselves as they walked around the store, although they looked like they were also seriously discussing something as well. They kept quietly chatting to each other before they took notice of you, giving small waves and warm smiles as they began to walk over towards you. The ginger girl quickly speaks up and puts out her hand "hello! My name's Connie! Are you new here??" Her smile warmly grew as you took and shook her hand, you gave her a warm smile back. "Yea.. me and my father live slightly out of town but we're practically on the edge." You said nervously, not knowing if they knew what you were talking about. Quickly the girl in the red v-neck tank top spoke up and said, "oh that old house!? I remember when a lil' old couple used to live there! Gosh! They were so sweet..my name's Julie by the way!" She giggled, and she gave a girly wave at you. You couldn't help but look at the middle girl, your brows slightly furrowed in worry at her quietness before Connie spoke up, "oh.. that's Ana, her sister went missing.. I'm sure you've already seen the posters around town by now." Her smile quickly faded while she spoke, Ana gave a quick half smile before turning around to look at the clothes on the wall. Julie gave a slightly worried look back at Ana before looking at Connie then back at you, "yea.. she's been in rough shape ever since. But she's been determined to find her…" Julie explained, before giving a big smile, "you should meet up with us at the roller rink tonight! It's always Nice to have new friends!" She yelled excitedly, jumping excitedly. Connie also seemed to get excited by this and nodded in agreement, her smile nearly blinding you with excitement. You smiled joyfully at the idea and soon nodded and agreed to join them later at the roller rink. You wanted to explore a little bit more before meeting up with your father again to tell him the news.

A few minutes pass and the three girls soon leave the building with you before they split off into a different direction than you, leaving you alone. You look around and decide to walk down towards the post office to meet up with your father, however as you were walking you couldn't shake the feeling of being watched. Your eyes darted around and yet you couldn't see anything, you looked behind you and still nothing. You started to walk slightly faster down the street, pushing the feeling off as just being in a new town. Soon enough you make it to the post office as your father is walking out the doors, mail and other papers in his name. He walks slowly as he's ready the envelopes and other pieces of paper, his glasses at the end of his nose and his eyebrows slightly raised as he reads and mumbles to himself. He quickly takes notice of you and fixes his glasses as he opens the car door and puts the mail in the glove compartment, a large smile on his face as you walk over towards the car. "Soooo?!... Anything exciting happens sweetie?" He smiled, his hand on the top of the car door as he leaned against it slightly. You nod and smile, opening your door on the passenger side and getting in. Your father soon follows and sits in the car, closing the door behind him. "Made some new friends!.. they want me to meet up with them later tonight at the roller rink.." you smiled, your father giving you a big hug before laughing triumphantly. "OH! I knew you could do it! Making me so proud.." he smiled before starting up the car and started to drive, you leaned up against the car door and let the wind start to blow through your hair, the feeling of being watched still stayed as you were starting to leave town. Your eyes widened and noticed a figure watching you pass by, an almost sinking feeling as you drove by filled your stomach. Soon the feeling leaves as you drive out of town, the radio blaring music and your father embarrassingly dancing to you. You chuckled to yourself bringing your attention to the sun as it slowly went down, the sky starting to turn pink and shades of purple, A smile slowly appearing on your face as you drove home.

Today was a good day, yet you couldn't shake a weird feeling about that town.

END OF CHAPTER 1

If you got his far, I sincerely hope you enjoyed chapter 1! I know nothing "exciting" happened in this one, however I promise it'll get more interesting as we continue! 💋💋💋

Special Thanks and inspiration - @lil-spider 💋❤️

//CHAPTER 2//

[meditating-dog-lover]

Skin - emergency (graphic)

My hands were pretty dry all of today. At night after washing them I got pretty itchy and almost developed a flareup. Thankfully I was able to calm it down and relieve it by washing my hands under hot water (bad habit but it was an emergency). I applied Cerave healing ointment on my problem areas (hands, wrist, neck, mouth, and ears) and went to bed at around 11:30.

Then I woke up at around 12:30 with some itchiness on my mouth and ears, mostly my mouth as I felt some oozing on the corners.

I applied zinc oxide cream to relieve the discomfort, but I felt like I needed something stronger. I did end up itching my ears and they started to bleed and ooze.

It felt like ants crawling on my skin. Anytime there's a sensation of that, along with oozing upon itching, is a sign of staph. So I applied the tacrolimus and antibiotic on it. I know I'm treating the staph internally, but I'll probably benefit from doing so externally.

I did feel very uncomfortable, and the oozing causes even more itchiness. I applied this mix on my right thumb which has a lot of cuts. But I know I'll feel better after this. Thankfully it's not a case where I felt a sudden need to slather the tacrolimus on my hands. In fact I didn't, just a bit with the antibiotic mixed in right on my thumb that has cuts.

I have a red patch on my wrist and neck. These are no longer itchy and there is no open skin or oozing/bleeding. So I'll just let those heal on their own, and I did apply the Cerave healing ointment onto it. As long as those don't ooze then I'm happy.

I know healing is not linear and will flare up here and there. As long as there is a net positive - I will get a flareup here and there, but after applying some topicals it will recover quickly and won't be as inflamed as it was in the winter.

I've looked at pictures of my skin from last year. I remember having inflammation, but it wasn't this bad. I really don't know what triggered it to be this bad. I really do not want to live the rest of my life like this either. This is no way to live.

People who have healed themselves said it took 6-12 weeks, so really 2-3 months. So I'm not going to expect everything to heal by week 4 (next week) even though some of the supplements are a 4 week (~30 day) supply.

So yeah I had some flaring, it's okay. It's been worse in the past. With topical application it should recover by tomorrow. The fact that there is inflammation and infection externally means that I can benefit from sort of anti-inflammatory (not steroids) and anti-bacterial topical. I might even consider applying more antibotic to my ears because it looks and feels like impetigo. Kind of like when I had a (sorry tmi) skin fungal infection and kept on applying ketoconazole. So I'll see how the topical antibiotic can help here and there, even if the anti-inflammatory isn't extremely necessary. Afterall my condition is due to bacterial imbalances/overgrowth, which is what's driving the inflammation. I'm just a bit worried about longterm antibiotic use because it can cause resistance and kill good bacteria. But in my case it can be helpful.

So like I said I'm on week 3, almost a month. I'm really going to need more like 6-12 weeks on this, but I'll see with my doctor 2 weeks from now. Overall there is a net positive where my skin is clearing up, and the inflammation and flaring is occasional. It's not perfect but it's much better than January-March.

Update: my ears stopped itching, my mouth is still itchy but I'm not sure what ultimately caused it as my mouth is usually not this inflamed. I'll even consider applying more tacrolimus and antibiotic to these spots when I wake up tomorrow.

[literalbirdperson]

So I'm going to tell the story of my yesterday, which started with an appointment with an ENT and ended with me in the ER. I'm doing this in bullet points, because I am very tired. (Also incredibly angry, but that might be adding to the tiredness.)

1:00 PM. Check in at the new doctor's. The facility is clean and bright, and all the staff are really friendly! That's always nice.

Meet the ENT I was referred to. I like him immediately. He's got a really relaxed, informal manner, but also very clearly knows his stuff.

Talk about surgical history, since I've had several nose and sinus procedures.

Since one of the reasons I am there for ear pain and recurring sinus issues, he starts the exam. Ears look great, he says! The pain is probably referred pain from my mouth. Do I grind my teeth? Yeah, I used to, but I might be again due to The Maladies.

He checks the back of my throat. "Oh, you have tonsil stones?"

"I... I do?"

Then he pulls out the horrible snake camera, and I resign myself to discomfort while he tours my nose and sinuses. I watch the screen and make very attractive "man was not meant to feel something pressing against a sinus wall" noises while he digs around.

Investigation over, he gives me a tour! Everything is about what I expected, he shows me old surgery sites, and then scrubs the footage forward a bit and goes "but here's where your problem is."

See, the other problem is, I keep spitting out these awful discs of dried mucus. And they stink!

Well. It turns out that I have a chronic infection in my adenoids. And what I keep spitting out is from there. I'll spare you the details.

Gross! But treatment should be pretty simple if it's staph, which it usually is. A couple of rounds of antibiotics usually knocks it out. If not, we'll culture it and go from there.

"So my throat has been infected for over two years?"

"Maybe even a lot longer than that!"

So we have a game plan. His assistant checks me out, hands me some papers and says "here's your record and a paper copy of your prescription, but we faxed it to your pharmacy as well."

2:00PM. The pharmacy app isn't showing them working on the RX.

3:00PM. I call them to see what's going on, get into a verbal fight with the phone tree, am finally allowed to leave a message. I am polite!

3:15PM. Pharmacist calls back. "We don't have an RX for that medication for you." Cool. I'll check with the Dr and have him re-fax. Oh! I have a paper copy of the-- there is no RX in my discharge papers, either. Fine. Calling.

3:30PM. There's nothing to re-fax, either, as the prescription was never even entered into my medical records! They are so sorry about the oversight, this is being flagged as high priority and his assistant will call you to let you know when it's been faxed to the pharmacy.

5:00PM. Why did I think something was going to go right for me medically? Why? Why me? Exhausted chronically ill/disabled breakdown incoming.

5:13PM. Text from pharmacy. They're working on the RX. It will be ready by noon tomorrow. Do you need it sooner? [YES]

5:15PM. Your prescription is ready.

5:30PM. Emotional collapse staved off for another day. Go to get RXs, with plans to stop to get ramen with spouse across the street from the pharmacy and enjoy the week being over.

5:45PM. Pharmacy tech tells me to go to the consult window if I want to talk about the antibiotic. Since it's completely new, I head over.

5:55PM. Pharmacist storms over, very clearly annoyed, and at me, not in general. Makes direct eye contact with me and starts reading me, word for word, the information on the bottle like I am a small child who can't read. I just wanted to know if there were any worrisome side effects.

Tell her to "have a good night!" She scoffs, literally holds up her hand in a "shut the fuck up" gesture and storms off.

Me and my spouse: "Huh. That was weird."

6:00PM. Take first dose of antibiotics with dinner to help keep stomach upset to a minimum.

7:00PM. Hives break out on my forehead. Then my thigh. Then my arms. Then suddenly my skin is bright red, bumpy, and burning literally everywhere.

That's not good. So I start looking up Bactrim side effects, since the pharmacist didn't deign to tell me. Discover I am having an allergic reaction, but only need to go the ER if my lips and face begin to swell, my vision gets blurry, or I have heart palpitations.

8:00PM. Lips are tingly. Look in mirror. I am lobster red and my face is swollen, as are my lips! I take two benedryl and both my inhalers, and we start looking for which ER to go to.

While we're looking, throat starts to swell. Swallowing is becoming impossible. Closest ER it is, even though I fucking hate it there. But it's a mile away and I want to be where the adrenaline and intubation kits are in case this keeps getting worse.

I am going to regret that decision.

Am forced to go through security and submit to a bag check before I can enter the ER itself. While actively struggling to breathe, which is distressing to both me and the guard.

Receptionist asks what I am there for. "I'm having an allergic response to an antibiotic. I can't breathe well."

She hands me a ten-page thick clipboard and tells me to fill it out, and then she'll get me in the queue.

What queue? There are TWO OTHER PEOPLE HERE. (See, everyone hates this hospital.)

So I start struggling to fill out the paperwork, but I am now to the blurred vision, mental confusion state. I keep having to pause to gasp for breath, and my penmanship is fucked because my hands are shaky from either albuterol or fear.

Spouse walks the paperwork back over to the receptionist.

We spend another 15 minutes sitting there while I am gasping for breath and grabbing at my throat every time I try to swallow because it feels like I'm being STRANGLED.

Nurse comes out to bring me back. We get intercepted by an angry man who has been watching me slowly dying but is still pissed because he got there first.

Nurse takes the time to explain to him what triage is while spouse literally holds me up.

I get a bed. Nurse tells me I'm having a classic allergic reaction and I'll probably be right as rain after some steroids. Hooks me up to all the monitors, tells me the doctor will be right in.

Doctor comes in. Listens to my lungs. Tells me my throat is not swollen even though she tried to grab to hold me upright when trying to swallow made me look like a gagging cat. But, my lungs are clear! Tells me they're going to monitor me to make sure I don't get worse, but she doesn't see anything to worry about.

LADY MY SKIN IS AS RED AS A VAMPIRE'S FAVORITE PAINT SWATCH FOR THEIR BEDROOM REMODEL.

She leaves. another nurse with the bedside manner of someone who enjoys kicking puppies walks in and starts taking my blood pressure.

The alarms go off.

"He put the cuff on wrong," he mutters, then wraps it so hard it hurts and runs it again.

The alarms go off.

"Do you have high blood pressure?" Mildly. NOT LIKE THIS.

"I'm going to go get the doctor." He leaves. He does not turn off the shrieking blood pressure machine.

10 minutes later: it's still screaming. Nobody has come by.

20 minutes later: see above.

30 minutes later: see above, except this time I start my stopwatch.

1 minute later: I get up and turn the fucking thing off, then unhook myself from everything.

40 minutes later: I am now itching so badly that I am scratching my arms bloody.

45 minutes after that, Puppykicker comes back in. "You ready to go home?"

Me, unnaturally red with hives so intricate that there are probably braille words on me, no longer struggling for breath, but 100% more bloody than I was when he walked out of the room an hour and 40 minutes ago: "Actually I'd like to speak with the doctor. I'd like to discuss steroids, since I am itchy."

"I'll go get her." Sure, Jan.

5 minutes later: Puppykicker comes in with a glass of water and a tiny cup of MASSIVE prednisone pills. "Here's 50mg prednisone. She says you're ready to be discharged."

The doctor. Is giving me. 50mg prednisone. Without speaking to me to see if I am allergic to it. When I came in with a severe allergic medication reaction. And is going to discharge me rather than wait around to see if I'll be ok.

Nurse watches me choke and struggle to take the pills. Because we're also giving an oral steroid to the bitch who can't swallow. Puppykicker does NOT care.

At that point, risking it and calling an ambulance if my throat closed up again was more worth it than staying there. Went home, stayed up long enough to confirm I am not going to start gasping for breath again. Passed out for two hours, got woken up by all 3 cats fighting over who gets to be in my lap. I have been taking two benedryl every 4h for the itching/hives and while my skin is its normal color again, everything itches so bad.

So my ENT is going to get a fun surprise on Monday when I inform him that the meds I had to fight to actually obtain have now left me with a hospital bill.

I also made an appt with my PCP, because this is the second medication since May that has done this to me. And they are not even remotely related to one another.

I guess what's 3 more days of living with a throat infection I've had for months, at a minimum?

[sickviking-fr]

To the tune of "He's got the whole world in his hands"

I've gotta Staph infection

In my ear

I've gotta Staph infection

In my ear

"Just tell how did it

Get in there?"

Well I have no fucking idea~~

So anyway. That explains why three rounds of antibiotics didn't do shit.

[nursingwriter]

EAR Infections Fundamentals of Nursing (Bataan Peninsula State University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Ear Infections Microbiology and Parasitology – Lecture These include: Otitis externa, otitis media, mastoiditis Otitis externa • Pain and itching that results may be severe because of the limited space for expansion of the inflamed tissues. • Otitis externa can be subdivided into 4; 1. Acute localised otitis externa, 2. Acute diffuse otitis externa 3. Chronic otitis externa and 4. Malignant otitis externa. • Infection of the external auditory canal (otitis externa) is similar to infection of skin and soft tissue elsewhere. • Unique problems occur because the canal is narrow and tortuous, fluid and foreign objects enter, are trapped and cause maceration and irritation of superficial tissues. Structure – Ear canal • The external auditory canal is about 2.5cm long from the conchae of the auricle to the tympanic membrane. • The outer half of the canal is cartilaginous, the medial half tunnels through the temporal bone. • A constriction, the isthmus is present at the juntion of the osseus and cartilaginous parts. • The skin of the canal is thicker in the cartilaginous portion and includes a well developed dermis and subcutaneous layer. • The skin lining the osseus portion is thinner and and lacks a subcutaneous layer. • Hair follicles are numerous in the outer third and fewer in the inner 2/3 of the canal Aetiological agents • The microbial flora of the external Canal is similar to the flora of the skin elsewhere. • There is predominance of staph. Epidermidis S. aureus and corynebacteria and lesser extent anaerobic bacteria like propionibacterium acnes • Others streptococcus pneumoniae, Haemophilus influenza, moraxella catarhalis • Gm neg bacilli – Pseudomonas aeruginosa Pathogenesis • The ear canal epithelium absorbs moisture from the environment. • Desquamation of the superficial layers of the epithelium may follow; In this warm moist environment, the organisms in the canal may flourish and ivade the macerated skin. • Inflammation and suppuration folllow. Clinical Manifestations Acute localised otitis externa • may occur as a pustule or furuncle associated with hair follicles. - Staph aureus. Erysipelas • caused by group A sreptococcus, may cause hemorrhagic bullae on the canal and tympanic membrane. • Adenopathy in the lymphatic drainage areas is often present. • Treatment o Depends on presentation; o Systemic antibiotics/ Incision and drainage. Acute diffuse otitis externa (swimmers ear) • occurs mainly in hot and humid weather. • Ear is itchy, painful and canal is edematous and red. • Gm neg bacilli esp P aeruginosa. • Treatment: topical eg neomycin/polymyxin in steroid/systemic antibiotics Chronic otitis externa • due to irritation of drainage from the middle ear in patients with chronic suppurative otitid media. • Itching may be severe. Management is by treating the otitis media also. • Organisms rare - mycobacteria, treponemes, yaws, leprosy. Invasive malignant otitis externa • is a severe necrotizing infection that spreads from the squamous epithelium of the ear canal to adjacent areas of soft tissue, blood vessels , cartilage and bone. • This invasive otitis externa is associated with pain and tenderness of the tissues around the ear and mastoid accompanied by pus drainage from the canal. Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 • At risk include diabetics, immunocompromised, debilitated and elderly patients. • Complications: life threatening disease may result by spread of infection to the meninges and brain. • Cranial nerves 7, 9,10,12 may be paralysed. • Cause: P aeruginosa. • Treatment: Clean the canal devitalised tissues removed,ear drops with antipseudomonal and steroid activity given and systemic therapy for 4- 6 weeks.ticarcillin/piperacillin/a ceftazidime with aminoglycoside Otitis media • Defined by presence of fluid in the middle ear accompanied by signs and symptoms of the illness. • Peak incidence occurs in the first 3 yrs of life. • The disease is less common in the school aged child, adolescent and adult. Associated factors Otitis media has been associated with; • Immunosuppression, passive smoking, poor breastfeeding, introduction of infants into large day care groups, • Race and ethnicity – canadian eskimos and australian aborigines have extraordinary incidence and severeity of otitis media. • Age at the time of first episode of acute otitis media is a powerful predictor of recurrent middle ear infections. • Males > females • Some children have anatomical changes- cleft palate, cleft uvula, submucous cleft – or alteration of the normal physiologic defenses-patulous eustachian tube. Pathogenesis • The middle ear is lined by respiratory epithelium with ciliated cells mucus secreting goblet cells and cells capable of secreting local immunoglobulins. • Anatomic or physiological dysfuntion of the Eustachian tube appears to play a critical role in the development of otitis media. • The eustachian tube has at least 3 physiologic functions with respect to the middle ear; 1. protection of the ear from nasopharyngeal secretions, 2. drainage into the nasopharynx of secretions produced from the middle ear, 3. Ventilation of the middle ear to equilibrate pressures to be as the atmospheric –external ear canal pressure. • When one or more of these functions is compromised, accumulation of fluid in the middle ear and subsequent infections may occur. • (congestion of the mucosa of the eustachian tube can result in obstruction; secretions that are constantly formed by the mucosa of the middle ear accumulate behind the obstruction, and If a bacterial agent is present, a suppurative otitis media may result.) Bacterial agents • Streptococcus pneumonia, Haemophilus infleunza, Staphylococcus aureus, Group A streptococcus, Moraxella catarhalis. • Others chlamydia trachomatis, mycoplasma pneumonie, diphtheritic otitis, mycobacterial tb and chelonae Clinical course Acute otitis media • the presence of fluid in the middle ear along with signs/symptoms of acute illlness. • Signs and symptoms may be specific eg ear pains, ear discharge,hearing loss; or non specific eg fever, irritability,lethargy. • Vertigo, nystagmus,tinnitus can also occur • Fluid can persist in the middle ear for prolonged periods after onset of acute otitis media even though symptoms may resolve within a few days of intiation of antimicrobial treatment • The common causes of otitis media are recovered frequently in cultures. • However if the patient is toxic or has focal infection elsewhere,culture of the blood and the focus are warranted. • Needle aspirations of the middle ear fluid (tympanocentesis) can be done in critically ill patients,the patient who has not responded to the initial antimicrobial therapy in 48-72 hrs and is toxic, and patient with altered host defences eg immunological defect including the newborns. Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 • Treatment o Amoxicillin – clavulanate, cefuroxime, cefixime, erythromycin. o Role of oral and nasal decogestants given alone or in combination with antihistamine – may relieve obstruction of the eustachian tube. Chronic otitis media • This term includes recurrent episodes of acute infection and prolonged duration of middle ear effusions usually resulting from a precious episode of acute infection. • Recurrent episodes of acute infection can be managed by chemoprophylaxis (eg amoxicillin given in winter and spring) and immunoprophylaxis = pneumococcal vaccination • Middle ear effusions can be managed surgically • This can be by Myringotomy - incision of the tympanic membrane, adenoidectomy, and insertion of tympanostomy tubes Mastoiditis • The proximity of the mastoid to the middle ear cleft suggests that most cases suppurative otitis media are associated with inflammation of the mastoid air cells. • Hyperaemia, edema, serous then purulent exudate collects in the cells • Bone necrosis due to pressure of the exudate. Clinical Manifestations Acute mastoiditis • usually accompanied by acute infection in the middle ear. • Specific features of mastoiditis include swelling, redness and tenderness over the mastoid bone; pinna is displaced outward and downward and a purulent discharge may be seen after perforation of the tympanum. • Chronic otitis media with mastoiditis can erode through the roof of the antrum causing temporal lobe abscess or extend posteriorly causing septic thrombosis of the lateral sinus. • Diagnosis: o Specimen- pus discharge from ear, freshly from the tympanic membrane o If the tympanic membrane is not perforated,tympanocentesis should be performed to obtain specimen from middle ear. o Cultures for bacteria • Treatment: • Antibiotics are similar as those used in otitis media • If the disease in the mastoid has had a prolonged course,cover for staph aureus and Gm neg enteric bacilli for initial therapy until culture results ready. • Mastoidectomy - when mastoid abscess forms and sepsis has been controlled by antibiotics. • Summary of pus examination DAY1; 1. description of specimen macroscopicallycolour,blood stain 2. culture on BA/Mac/Neomycin blood agar if anaerobic infection suspected/LJ media for recurrent or chronic otitis media/SDA 3. Gram smear –pus cells and bacteria ZN smear/KOH preparation/Darkfield mic DAY 2 onwards; - Examine and report cultures Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Read the full article

[fyodors--ushanka]

Hey guys! I will probably be returning soon, but I currently have a Staph infection and I am extremely dehydrated. I still can't take my iron supplements because of penicillin (Iron supplements hinder medication absorption). But please don't worry, I am taking care of myself. I am resting up and hydrating myself. I just got over an ear infection and got thorn in my finger, which had unfortunately got infected. Ironically, was a fuck you from mother nature on my fuck you finger. I will try to get my health back on check. Thank you for reading this.

[ofmymanymuses]

There's some virus going around my work right now that has given multiple people sinus/ear infections, a staph infection, and I had strep. All because they won't hire a REAL cleaning crew.

Literally cannot wait to quit my job when I move in a few months this is fucking ridiculous. I'm fucking sick and tired of being sick and tired all of the time

[ranger-kellyn]

Of fucking COURSE!!!!!! Minutes before i have to go to my massage appointment i discover a gross little bump on my arm that looks like the bump I got when i had a staph infection as a kid AND the bump behind my ear from the piercing is black and gross and!!!!!!!! I’m so sick of this piece of shit body!!!!!!!!! I’m so sick of NEVER catching a break!!!!! Kill me!!!!!!!!!!!!!

[akashtnwhizsoln]

Understanding Antibiotics: When Are They Necessary?

Are you wondering if an antibiotic is the solution to your stuffed-up nose, headache, and sore throat?

When you're feeling under the weather, all you want is quick relief. Your usual remedies like zinc, elderberry, and vitamin C may not be doing the trick, and your patience, along with your box of tissues, is running out.

While it may be tempting to seek an antibiotic prescription from your healthcare provider, it's important to know that antibiotics may not always be the answer. Antibiotics are designed to treat bacterial infections, and they won't help if your illness is caused by a virus.

"Antibiotics are powerful medications that have saved countless lives over the past century, but many people rely on them excessively when they aren't necessary," said Dr. Akash Ferdaus, MD, Primary Care Physician at Akash Medical Care PLLC in Brooklyn, NY.

Why is this a concern?

Because it has led to a surge in antibiotic-resistant bacteria. Before you ask for a prescription or your healthcare provider suggests one, let's explore why antibiotic-resistant infections are alarming and when antibiotics may or may not be effective when you're feeling unwell.

The Emergence of Drug-Resistant Bacteria

According to the Centers for Disease Control and Prevention (CDC), nearly one-third of antibiotics prescribed in the U.S. are inappropriate for the conditions being treated.

Taking antibiotics may seem harmless, but their overuse makes them less effective, even if you only take them occasionally. "This could become a significant problem if you develop a life-threatening infection caused by a bacterium that has become resistant to all available antibiotics," explained Dr. Akash Ferdaus.

Bacteria are smart and have evolved to survive future antibiotic use, even if it's not used for its intended purpose, such as treating a viral infection.

"The antibiotic won't cure the viral infection, but it will attack harmless bacteria, and these bacteria will adapt to avoid future attacks," Dr. Akash Ferdaus said.

To combat antibiotic resistance, healthcare professionals are taking several measures to protect patients from drug-resistant infections, including:

Prescribing antibiotics only when necessary.

Ensuring the appropriate antibiotic is used at the correct dosage and for the right duration.

Educating patients about the risks associated with antibiotics they're taking.

Encouraging patients to discard any leftover medication after completing their prescribed treatment course.

What Can Antibiotics Treat?

Antibiotics are effective against bacterial infections only. "They work against bacteria like streptococcus or staphylococcus by either killing them or preventing their replication," explained Dr. Akash Ferdaus.

Antibiotics should be taken when prescribed by a healthcare provider for specific bacterial infections that are unlikely to resolve on their own.

Examples of bacterial infections include:

Strep throat

Middle ear infections

Urinary tract infections

Pneumonia

Skin infections, such as impetigo and staph infections

Whooping cough

Sexually transmitted infections like chlamydia and syphilis

What Can't Antibiotics Help Treat?

Antibiotics are ineffective against sicknesses caused by viral infections. Unfortunately, most viral infections, including the common cold and flu, simply need time to run their course, which can take two to four weeks.

Examples of viral infections include:

Cold

Parainfluenza

Influenza (flu)

COVID-19

Bronchitis

Most coughs

Most sore throats

"Keep in mind that most coughs can last up to 18 days after an upper respiratory infection, so patience is necessary," advised Dr. Akash Ferdaus. "Coughs don't require antibiotics, and this can be challenging for those seeking instant relief."

Viruses like COVID-19, HIV, and flu aren't treated with antibiotics but may be treated with antiviral medications in some cases. Antiviral medications can help alleviate symptoms and shorten the duration of a viral infection.

What Are the Possible Side Effects of Antibiotic Use?

Antibiotics can have mild to life-threatening side effects, including diarrhea, rashes, and allergic reactions. According to the CDC, adverse reactions to antibiotics account for 1 in 5 medication-related emergency room visits.

"Many people believe antibiotics are harmless, but the reality is that these side effects can occur in anyone, even if they've previously tolerated antibiotics," cautioned Dr. Akash Ferdaus. "One common side effect is diarrhea since antibiotics not only kill the infection but also the beneficial bacteria in your gut."

Your digestion and mood can be affected because 90% of our happy hormone, serotonin, comes from our gut. Removing the microbiome, or the good gut bacteria, can lead to diarrhea, cramping, and gas. In severe cases, long-term use can even result in C. diff, a severe infection that causes colitis or inflammation of the colon.

When Should You Schedule an Appointment?

If your symptoms start to improve on their own or with the help of over-the-counter medications after a week, it's likely a viral infection. However, if your symptoms persist for 10 days or worsen after initially improving, bacteria may be involved, requiring a prescription.

"Seek immediate medical attention if you're experiencing difficulty breathing or severe pain," advised Dr. Akash Ferdaus.

In Conclusion

Antibiotics should only be used to treat bacterial infections and are ineffective against viral infections. Using antibiotics when they're unnecessary can lead to antibiotic resistance and potential side effects.

While you shouldn't fear antibiotics, it's crucial to use them responsibly to ensure their efficacy when they're truly needed in the future.

[devourerofcheesecake]

If you get this, answer with 3 random facts about yourself and send it to the last 7 blogs in your notes, anonymous or not! Let's get to know the person behind the blog 🌻 (lol if you wanna do the cheesy thingy)

1. travelled and met an online friend in Wisconsin. We swam in the Great Lakes a lot, and I kind of forgot to shower that whole entire time. This resulted in a huge staph infection on my neck. There’s a lil more to this story, but I think it showcases how blatantly unobservant I am.

2. When I got my first pixie haircut, dad got suuuuuper antsy. People started calling me a boy, and Dad got kissed about it. He wanted to make it a little more obvious that I was a gal. His solution; earrings.

For context, I was terrified of needles for the longest time, and had zero interest in hurting my ears. So we made a bet. I would get a small dog (dad hates those purse dogs) and in exchange I’d get my ears pierced.

I got two infected ears, and one dog named Starfire Snugglepumpkin Blueberry Hand-eater the 3rd. I’ve since given away my pup, and she’s dearly missed. I also have an obsession with earrings now.

3. I’m a menace in bed, and what I mean by that is I sleep like the dead.

-When my mother was having a medical emergency, Dad woke me up and told me to get ready. He came back in three minutes to see me sleeping while standing up.

-During my brothers birth, my fam was trying to wake me up, and they did everything just short of pouring water on my head. They straight up slammed a metal chair loudly to wake me, and I did not stir.

-Whenever I slept with my parents, I would be impossible to move. I was like a tick, you could not move me from the sheets. No amount of pushing would get me off the bed. My parents can lift some heavy weights, and yet they could not pull me off the bed. This is annoying because I sometimes kick in my sleep, and this woke my parents constantly. I was rarely allowed to sleep with my parents past the age of 7.

-As a baby, I always slept with my arms over my head. Even when mom put me in the tightest swaddle, I could not be contained. I’m the breaker of chains, the swaddle could never contain me.

[appetite4savage]

there is no valid reason why my prescription ear drops cost four hundred dollars and insurance doesn’t cover them

[daijouboobies]

people only see me for my staph infection and not for the person i really am

[nursingwriter]

CMN 568 Unit 1 Management of Ear Infections Study Guide with complete solutions nursing assistant course (The Nairobi West Hospital College Of Health Sciences) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 CMN_`-568_`-Unit_`-1:_`-Management_`-of_`-Ear_`-Infections_`-Study_`-Guide_`- with_`-complete_`-solutions._`- 1 / 10 1. What is proper otoscope technique? 2. Explain the division of the ears 3. Why do you want to palpate the mastoid process during a suspected ear infection 4. Malleus (begining part of the bone) Umbo (tail end of the bone) Cone of light (either 5'oclock (R hold it like a pencil bracing his finger against the child's cheek, if patient moves, so does otoscope Outer ear Ear canal Middle Ear Ear drum Malleus Incus Stapes -Eustachian tube Inner ear Coclea Semicircular canals- fluids in there move when you move your head and that tells your body where you're at in space. Problems here is what can cause vertigo. Because of risk for mastoiditis Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 CMN_`-568_`-Unit_`-1:_`-Management_`-of_`-Ear_`-Infections_`-Study_`-Guide_`- with_`-complete_`-solutions._`- 2 / 10 ear) or 7 o'clock (L ear)) 5. What is the other name of otitis externa 6. What is Otitis Externa 7. What are the pathogens that cause otitis externa 8. What are risk factors for otitis externa 9. Pictire of otitis externa 10. If they have otitis externa what happens if you push on the pinna or pull on the tragus 11. What are s/s of otitis externa Also called Swimmer's ear It's Cellulitis of the soft tissues of the external auditory canal Pseudomonas aeruginosa Staphylococcus aureus Aspergillus or other fungus (especially diabetics) Moisture in the ear from swimming, showering, etc Trauma to the external canal fro Q-tips, ear plugs, hearing aids, or scratching Keeping ears too clean removes protective cerumen and increases pH which promotes bacterial growth They will have pain You won't necessarily see this with otitis media Edema and erythema of external canal, may be swollen Severe ear pain, made worse by movement of pinna or Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 CMN_`-568_`-Unit_`-1:_`-Management_`-of_`-Ear_`-Infections_`-Study_`-Guide_`- with_`-complete_`-solutions._`- 3 / 10 12. What is one of the first thing you need to do when trying to treat otitis external 13. Steps to treating otitis externa 14. What are antibiotics to use for otitis externa tragus Purulent discharge from the external canal, canal may be filleed with debris, making visualization of TM diffiuclt or impossible May have periauricular or cervical lymphadenopathy make sure you can visualize TM. If you can not visualize TM due to swelling or debris MUST assume perforation and manage accordingly Make sure you can visualize TM Remove debri from canal if possible. If TM is intact you can irrigat with NS and a bulb syringe. Do NOT irrigate if TM is not intact or cannot be visualized Pain control: acetaminophen or ibuprofen for mild pain, may need narcotic analgesic for severe pain. It's usually bacterial though it can be fungal topical ear drops are recommended nless there are signs of systemic symptoms Fluroquinolone drops are first line: •Ciprofloxacin/dexamethasone (Ciprodex) contain cipro and a steroid for inflammation. •4 gtts BID x 7 days •Covers pseudomonas and Staph •Safe to use if TM is perforated or PE tubes are in place •Neomycin/ Polymyxin B/ Hydrocortisone (Cortisporin otic) •3-4 gtts TID-QID for 7-10 days •Do NOT use if TM is perforated or PE tubes in place Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 CMN_`-568_`-Unit_`-1:_`-Management_`-of_`-Ear_`-Infections_`-Study_`-Guide_`- with_`-complete_`-solutions._`- 4 / 10 15. What antibiotic would you use for otitis media that's safe for perforated TM or if PE tubes are in place? 16. For otitis externa can you use Neomycin/ Polymyxin B/ Hydrocortisone (Cortisporin otic) If they have a perforated TM or PE tubes? 17. What can you do if the kid has acute otitis externa and the canal is too swollen for ear drop 18. What are some ways to prevent otitis externa? 19. Fluroquinolone •Ciprofloxacin/dexamethasone (Ciprodex) contain cipro and a steroid for inflammation. NO Use an ear wick Insert dry wick into ear canal Put the drops on it and it expands. Wick will fall out when swelling decreases. •Avoid vigorous ear cleaning which removes protective cerumen and changes ph. •Avoid use of Q-tips which can damage ear canal. •Use drying agents after swimming: •2-3 gtts of 1:1 solution of white vinegar/ 70% ethyl alcohol •Commercial products such as Swim Ear drops •Acidify and dry canal to inhibit bacterial growth Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 CMN_`-568_`-Unit_`-1:_`-Management_`-of_`-Ear_`-Infections_`-Study_`-Guide_`- with_`-complete_`-solutions._`- 5 / 10 If a patient has swimmer's ears would you use swim ear drops or the 1:1 solution of white vinegar/ 70% ethyl alcohol? 20. What is acute otitis media (AOM) 21. What are the two things you need to diagnose acute otitis media? 22. What are the pathogens that usually cause acute otits media? 23. What are some risk factors for acute otitis media. No it would burn. Also if there's a perforation you don't want it going to the middle ear. •Acute infection of the middle ear space with inflammation and effusion •A bulging TM •Middle ear effusion (MEE) as demonstrated by pneumatic otoscopy or tympanometry •Streptococcus pneumoniae (35-40%) •Haemophilus influenzae (30-35%) •Moraxella catarrhalis (15-25%) •Streptococcus pyogenes •Eustachian tube dysfunction: equalizes pressure and allows drainage from middle ear. Tubes in infants are shorter, wider, floppier and more horizontal that in adults, making them prone to dysfunction. •Bacterial colonization of the nasopharynx with AOM pathogens •Viral URI: inflammation of eustachian tubes impairs function leading to middle ear effusion •Smoke exposure: inflames eustachian tubes, impeds drainage, and increases pathogen colonization •Impaired immune defense: children with disorders that cause immunocompromise are at increased risk Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 CMN_`-568_`-Unit_`-1:_`-Management_`-of_`-Ear_`-Infections_`-Study_`-Guide_`- with_`-complete_`-solutions._`- 6 / 10 24. What are difference between signs vs symptoms? 25. What are clinical symptoms of acute otitis media? 26. What are signs of acute otitis media? 27. What are treatments for AOM •Bottle feeding: Breast feeding has been shown to decrease risk of AOM. Bottle feeding, especially if the bottle is propped, increases the risk •Craniofacial disorders such as Down's Syndrome and cleft palate •Daycare attendance: children in daycare have more exposure to URI and more AOM •Time of year: AOM increases in winter months along with viral URI symptoms: things the patient/ patient tells you or reports signs are things you can detect yourself •Ear pain: pulling or tugging on ear in young infant •Fever •Bulging, inflamed (erythematous) TM •Signs of effusion: decreased mobility of TM on insufflation with pneumatic otoscope or flat tympanometry wave •Loss of bony landmarks and light reflex on otoscopic exam •Yellow or white effusion behind TM (pus) •Purulent drainage (otorrhea) if TM is ruptured or patent PE tubes in place pain management (it's painful) Observation period: A period of "watchful waiting" is apDownloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 7 / 10 28. Observation Options Chart 29. What is the initial treatment for acute otitis media? First line? 30. What is the first line drug for acute otitis media? 31. What is the dosage for Amoxicillin? propriate in otherwise healthy children > 6mo with the ability to be closely followed and antibiotics provided if symptoms worsen or fail to improve in 48-72 hours. First-line: •Amoxicillin: 80-90mg/kg/day divided BID, max 1000mg/dose, 2000mg/day •Child weighs >40 kg, 500-875mg po q12 h (adult dose) •Duration: < 2yr or any age with severe symptoms: 10 days •2-6yr mild-mod symptoms: 7 days •> 6 yr: mild-mod symptoms: 5 days Alternative: PCN causes papular rash (but no wheezing or coughing) give cephalosporin: •Cefdinir, Cefuroxime, Cefpodoxime •Ceftriaxone 50mg/kg IM for 1-3 days if unable to take po meds Severe PCN allergy (hives/ anaphylaxis): •Trimethoprim-sulfamethoxozole (Bactrim) •Macrolides: azithromycin, EES •Clindamycin Amoxicillin: 80-90mg/kg/day divided BID, max 1000mg/dose, 2000mg/day •Child weighs >40 kg, 500-875mg po q12 h (adult dose) •Duration: < 2yr or any age with severe symptoms: 10 days •2-6yr mild-mod symptoms: 7 days •> 6 yr: mild-mod symptoms: 5 days Amoxicillin: 80-90mg/kg/day divided BID, max 1000mg/dose, 2000mg/day •Child weighs >40 kg, 500-875mg po q12 h (adult dose) Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 8 / 10 32. What do you do if (acute otitis media) a patient has taken amoxicillin in the past 30 days or who fail to improve in 48-72 hours on amoxicillin, or has otitis-conjunctivitis syndrome: 33. What is the treatment of child with tympanostomy tubes and otorrhea but no systemic symptoms such as pain or fever: 34. What do you do if a child has a recurrence of otitis media > 4 weeks 35. What are some reasons why antibiotics fail? •Amoxicillin-clavulanate ES (Augmentin ES). Use formulation with 90mg/kg of amoxicillin. Dose 90mg/kg/d divided BID (you dose it based on the Amoxicillin) OR •Ceftriaxone 50mg/kg/day for 3 days Alternatives: •Clindamycin with or without 3rd generation cephalosporin such as ceftriaxone •Tympanocentesis (Refer to specialist (ENT)) •Flouroquinolone otic drops (cipro otic) are first line It's likely a new pathogen, start with amoxicillin or other first-line treatment. Drug-resistant pathogen: •Do not use macrolides such as azithromycin or clarithromycin after failure of amoxicillin due to high resistance of H. flu and Strep pneumoniae Non-compliance: •may need IM ceftriaxone Vomiting of medication/ medication refusal: •cephalosporins are often bitter, may be improved with flavoring Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 9 / 10 36. How do you prevent acute otitis media. 37. What is otitis media with effusion (OME) 38. What are some symptoms of otitis media with effusion (OME) 39. What are some signs of otitis media with effusion (OME) 40. •Avoid second-had smoke in child's environment •Encourage breast feeding •Discourage bottle propping if bottle feed •Discourage pacifier use after 6 months (use may reduce SIDS in infants < 6mo) •If possible, find child care with fewer children •Antibiotic prophylaxis is NOT recommended due to increase risk of developing antibiotic resistance. •Vaccines: encourage use of Pneumoncoccal conjugate vaccine (PVC13) and yearly influenza vaccine. •Presence of middle ear effusion (MEE) without signs of acute inflammation •Usually painless •May precede or follow an episode of AOM On otoscope visualization note: amber color and retracted TM OR Note bubbles •Usually painless, but often report a sense of fullness or pressure •Decreased hearing •TM is either neutral or retracted. When TM is retracted, the bony landmarks become more visible •Decreased motion of the TM on pneumatic otoscopy or tympanometry •TM may have a whitish or amber color •Hearing impairment on audiometry Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 10 / 10 What are some risk factors of acute otitis media? 41. Tx of acute otitis media with effusion? 42. Tympanostomy tubes:pressure-equalization (PE) tubes 43. What are the Complications of acute otitis media After AOM, fluid remains in middle ear for several weeks: •2 weeks after AOM: 60-70% will have OME •4 weeks after AOM: 40% will still have OME •3 months after AOM: 10-25% will have AME •Otitis media with effusion without signs of acute inflammation/infection will NOT benefit from antibiotics therapy and none is recommended. •Have child return at 4 week intervals to check progress •Refer for audiology evaluation after 3 months of continuous effusion in children < 3yr or at risk of language delay •Children with hearing loss or speech delay should be referred to ENT for possible tympanostomy tube placement •This shows 2 types of PE tubes in place. Tubes are different colors. They often fall out on their own after a few months. •Tympanosclerosis: scarring of the TM and middle ear structures resulting in conductive hearing loss •Tympanic membrane rupture: presents with drainage from the ear. Usually heal on own, but may need repair. Keep water out of ear (No swimming, put vaseline in cotton and than in ear before showering.) •Cholesteatoma: granulation tissue develops causing a greasy-looking mass near a retraction pocket or perforation. Refer to ENT, surgery usually needed. Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Read the full article