Paediatrics - Queensland Health - Queensland Government

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Ear problems 586 Otitis media with effusion (OME) Painless non discharging ears, glue ear Recommend Review children with bilateral OME at 3 monthly intervals and refer if required <strong>Health</strong> clinics have targeted hearing health programs to focus on day care and pre school children where intervention may prevent ear damage and hearing loss. Personal hygiene in children - washing hands and face and keeping face clear of nasal discharge is most effective Provide full immunisation Background OME is diagnosed if thick fluid persists in the middle ear usually after AOM OME results in thick glue like material filling the middle ear which may take many months to resolve. It is important because children with OME will have impaired hearing. If hearing is impaired for a significant length of time especially at the critical age of language learning in the first 5 years it may result in significant long term disability Decongestants and antihistamines are not recommended [7] Steroids are not recommended [1] but inhaled steroids may be trialed in children where significant nasal obstruction, sneezing etc. suggests allergic rhinitis Related topics Acute otitis media Immunisation program Controlled copy V1.0 Assessment of the ear 1. May present with • Usually is asymptomatic • Parents may be concerned about the child’s hearing • Diagnosis may also be suspected at routine ear examination, in a child being followed up after AOM, or in a child referred for medical assessment because of hearing impairment on testing • Child may have: -- past history of recurrent otitis media -- concerns about speech or language development • Reported decrease in hearing • Reported poor hearing leading to learning difficulties 2. Immediate management Not applicable 3. Clinical assessment • Obtain a complete patient history. See Assessment of the ear • Perform standard clinical observations • Perform physical examination. See Assessment of the ear -- the following may be noted on examination ○ air / fluid level, bubbles behind the ear drum ○ retraction of ear drum ○ limited or absent movement of the ear drum with pneumatic otoscopy. This is the best way to diagnose - refer to audiology / MO to perform. Diagnosis is confirmed by tympanometry which shows a type B (stiff ear drum) pattern Primary Clinical Care Manual 2011
Ear problems 4. Management • Give amoxycillin • Arrange for audiology if there are concerns about hearing or speech or OME is persistent for > 3 months • Refer to ENT specialist: - - if hearing test shows moderate impairment in both ears for more than 3 months -- if there is speech delay and effusion persists more than 3 months or -- if there is more severe hearing impairment or concerns about the appearance of the drum • Encourage personal hygiene in children - washing hands and face and keeping face clear of nasal discharge • Breathe, blow, cough (BBC) program is for school aged children • Check immunisation status particularly Pneumovax and perform catch up immunisation if required Schedule 4 Amoxycillin DTP IHW / SM R&IP / IPAP Authorised Indigenous <strong>Health</strong> Workers and Isolated Practice Area Paramedic must consult MO / NP Scheduled Medicines Rural & Isolated Practice Registered Nurses may proceed Form Strength Route of administration Recommended dosage 250 mg Capsule Adult and child 500 mg Oral 25 mg / kg / dose bd 125 mg / 5 mL Suspension to a max. of 1 g bd 250 mg / 5 mL Provide Consumer Medicine Information Management of associated emergency: as for severe allergic reactions. See Anaphylaxis Duration 14 days [4] [6] • If not resolved may need a further 14 days to a total of 28 days. If allergic to amoxycillin see Antibiotics for acute otitis media 5. Follow up 3 monthly If OME persists for > 3 months arrange - audiometry and tympanometry See the current edition of the Chronic Disease Guidelines available at: www.health.qld.gov.au/cdg 6. Referral / consultation Next MO visit Refer to ENT specialist if: -- any concerns about hearing or speech -- problem remains longer than 3 months -- antibiotic therapy has failed -- has severe retracted ear drum If there is speech delay refer to Speech Pathologist If hearing is impaired in school children make sure the school is informed, with parental consent, as the teacher can use measures to assist child Primary Clinical Care Manual 2011 Controlled copy V 1.0 587
Page 1 and 2: Section 6 Paediatrics
Page 3 and 4: Paediatric presentation History and
Page 5 and 6: Paediatric presentation Presentatio
Page 7 and 8: Paediatric presentation Standard cl
Page 9 and 10: Paediatric presentation Physical ex
Page 11 and 12: Child with fever Fever is usually a
Page 13 and 14: Child with stridor Stridor is a har
Page 15 and 16: Any history of significant trauma?
Page 17 and 18: Meningitis Meningitis Recommend Co
Page 19 and 20: 6. Referral / consultation Consult
Page 21 and 22: Respiratory problems • For the ch
Page 23 and 24: Respiratory problems 1. May present
Page 25 and 26: Respiratory problems 4. Management
Page 27 and 28: Child < 3 months Contact MO immedia
Page 29 and 30: Immune complications Acute post st
Page 31 and 32: Immune complications Schedule 4 Ben
Page 33 and 34: Immune complications Acute rheumat
Page 35 and 36: Immune complications Australian gui
Page 37 and 38: presence of RHD Place person on Re
Page 39 and 40: Ear problems • Clean the ear usin
Page 41 and 42: Ear problems Acute otitis media (A
Page 43: Ear problems Schedule 4 Roxithromyc
Page 47 and 48: See Simple analgesia back cover Ear
Page 49 and 50: Ear problems 6. Referral / consulta
Page 51 and 52: Ear problems 5. Follow up Children
Page 53 and 54: Ear problems Ear discharge in the p
Page 55 and 56: Ear problems 4. Management • Cons
Page 57 and 58: Ear problems Schedule 4 Flumethason
Page 59 and 60: Ear problems Foreign body / insect
Page 61 and 62: Gastrointestinal problems Acute gas
Page 63 and 64: Gastrointestinal problems 4. Manage
Page 65 and 66: Gastrointestinal problems • Bottl
Page 67 and 68: Gastrointestinal problems Nutrition
Page 69 and 70: 5. Follow up Review 1 - 2 days aft
Page 71 and 72: Gastrointestinal problems Intestin
Page 73 and 74: Gastrointestinal problems Schedule
Page 75 and 76: Gastrointestinal problems 4. Manage
Page 77 and 78: Gastrointestinal problems Intussusc
Page 79 and 80: Gastrointestinal problems • Perfo
Page 81 and 82: Gastrointestinal problems Backgroun
Page 83 and 84: Schedule 2 Folic Acid Gastrointesti
Page 85 and 86: Urinary tract problems References 1
Page 87 and 88: Urinary tract problems ○ where no
Page 89 and 90: Bone and joint problems 3. Clinical
Page 91 and 92: Abuse and neglect 2. Immediate mana

Paediatrics - Queensland Health - Queensland Government

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