Transcript Case Scenario#2

Case Scenario#2
Lisa Gagnon, APRN
Connecticut Pediatric Otolaryngology
7th 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, had
failed 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!