Croup, Otitis Externa "swimmer's ear", Otitis Media

Croup etiology:

parainfluenzia virus or RSV; sometimes *Streptococcus pyogenes* (group a), *S pneumoniae*, *S aureus*

Croup is characterized by:

hoarseness, “barking” cough, inspiratory stridor, and varying degrees of resp. distress

Croup syndromes affect:

larynx, trachea, and bronchi → epiglottitis, laryngitis, laryngotracheobronchitis (LTB)

Acute epiglottis etiology:

*Haemophilus influenza* type b (Hib)

Prevention of acute epiglottis:

Hib vaccine

S/S of acute epitglottitis:

rapid onset, tripod positioning, drooling, dysphagia, muffled speech, retractions, inspiratory stridor, high fever

Dx testing for acute epiglottitis:

steeple sign (x-ray of the airway), thumb sign (lateral airway x-ray)

Therapeutic management for acute epiglottitis:

antibiotics, cool-mist humidifier, oxygen, IV fluids, monitor for drooling and tripod positioning (signs of airway obstruction requiring immediate intervention)

Do you swab a pt’s throat to test for acute epiglottitis?

no, you can compromise the airway

Acute LTB etiology:

*S. aureus*, RSV, parainfluenza virus

S/S of acute LTB:

inspiratory stridor, suprasternal retractions, barking or “seal-like” cough, increasing resp. distress and hypoxia, purulent sputum, high fever

Therapeutic management for acute LTB:

airway management, maintain hydration, I&Os (orally or IV), high humidity w/ cool mist, neubulizer tx, racemic epi, steroids

Otitis externa patho:

persistent excessive moisture causes inflammatory reaction in canal, pinna, and TM; worse in warm climates and summertime; long time submerged in water

Otitis externa etiology:

pseudomonas, candida, aspergillus; digital trauma, foreign body

S/S of otitis externa:

feeling of pressure/fullness, redness and edema of ear canal, itching, pain w/ chewing or when pinna or tragus is manipulated, no fever, otorhhea

Otitis externa dx:

H&P

Therapeutic management for otitis externa:

focus on prevention, keep canal dry, warm compress can help manage pain

Med for otitis externa:

ear drops (antibiotic/antifungal), glucocorticosteroids (prednisone), antipyretics/analgesics, NSAIDs

Otitis media etiology:

*Streptococcus pneumoniae, H influenza & Moraxella catarrhalis*; passive smoke increases risk, URI, allergic rhinitis or hypertrophic adenoids, breastfeeding babies have a lower risk; horizontal positioning and immature structure/function of the Eustachian tubes predispose small children

S/S of otitis media:

ear pain, fever, purulent discolored effusion and bulging, red, immobile tympanic membrane; irritability and ear pulling (initial sign in those non-verbal)

Therapeutic management for otitis media:

pharm → antibiotics x10-14 days, acetaminophen or ibuprofen for pain management, ear drops

Pt education for otitis media:

antibiotic admin, hold child upright when feeding, don’t prop bottle, no q-tips, no second hand smoke

Tympanostomy:

surgical tx for otitis media

→ child can have temp hearing loss after

→ child should not have ears submerged in water at all, no swimming for 2 weeks, no nose blowing for 7-10 days, keep ears dry (earplugs or cotton balls)