case scenario#2 lisa gagnon, aprn connecticut pediatric otolaryngology 7 th annual otolaryngology...

Case Scenario#2

Lisa Gagnon, APRNConnecticut Pediatric Otolaryngology7th Annual Otolaryngology Symposium

Initial presentation……

• 8 y/o female presented to her pcp with acute ear pain/bulging ear drum

• Dx: AOM

• Prescribed routine antibiotics and supportive care

Case progression

• Went to ED: Severe pain, on abx for AOM• Reported dizziness/vertigo & headache• Reported significant hearing loss• No change in treatment, plan

ENT Evaluation

• 9 months following initial AOM episode referred to ENT, hadfailed screen at school,then pcp 1 mo ago.• Formal audio: Unilateral profound to severe SNHL

PMH/FH

PMH: “Used to be prone to OM” ~2 years ago, had 1 perforation (?which ear) -Past 2 years- No recurrent AOM/CSOM -Prior hearing screens nl -No other risk factors for SNHL

FH: Neg hx hearing loss, genetic/chromosomal abnl

Further Evaluation- SNHL

• CT scan of temporal bones- WNL

• Ophthamology exam- WNL

Suppurative Labrythitis

• Labyrinthitis is inflammatory disorder of the inner ear or labyrinth.

• Caused by bacteria or viruses entering labyrinth causing acute inflammation

• May have disorder of balance/vertigo• May develop SNHL

Inner Ear Anatomy

Treatment

• If due to AOM….immediate tympanocentesis and myringotomy/PE tube insertion

• Possible mastoidectomy• Parental antibiotics (initially)• HT

• SNHL Treatment and follow-up

Thank you!