introductiondisclaimerdiagnosisandtreatmentofotitis.docVIP

Introduction/Disclaimer: Diagnosis and treatment of otitis media is about as bread-and butter pediatrics as you can get. This handout is not meant to cover the whole topic of otitis media, just some practical tips. TN put together most of the text; AM did the flowsheet and tables. Statements, drugs, doses, etc. here represent our current opinions; use your judgment about whether they apply to your patients and double-check drug doses. Some of this handout relates specifically to the childrens health center at San Francisco General Hospital. Examination tips to get a look at the TM HOLDING: Cooperative child, no wax: if the child is at least semi-cooperative or young (less than about 1 year) you can try the parents lap. To look at the right ear, have the patient sit on the parents right thigh, with legs between parents legs and left ear against parents chest. The childs left arm goes around the parents chest and the parent holds the right arm with one hand and immobilizes the head with the other. For the left ear, the position is a mirror image. Uncooperative child or wax removal: this is best done supine on the examining table. (This is definitely the case if you are using a rigid curette. For Calgi-Swabs the parents lap may be OK.) If the child flails his legs around you will not be able to see, therefore the best position is for the parent to place his or her axilla (axila in Spanish) over the childs two thighs just above the knee. She can then hold the hands down with her hands. You may be able to immobilize the head with the hand that holds the otoscope and use the other hand to pull up on the pinna. But you also may need another pair of hands to help immobilize the head, especially if you are going to try to remove wax. Ask the nurses (politely) to help you. Uncooperative and too big to restrain: rethink whether you really need to see the TMs. It usually is not worth it. If you really need to do it, get help. USING THE OTOSCOPE: First, make su