Paediatrics - Queensland Health - Queensland Government

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Ear problems Cleaning techniques for ears with chronic discharge Suction • Suction under direct vision is the most effective technique but this requires special equipment and training Dropper method • The ear canal can be cleaned by irrigating with clean water using an eye dropper • An eye dropper uses a small volume of wash solution at low pressure and is therefore relatively safe in unskilled hands • Eye droppers are cheap and easy to obtain and to clean for use at home Equipment • A clean eye dropper and bulb. This can be washed with soap and water or an antiseptic • A clean container of clean water (sterile or cool boiled) (some rainwater tanks may be contaminated) • Clean container for the dirty water from the ear Technique 1. The patient should be sitting or lying down with the affected ear upwards 2. Using a clean dropper filled with clean water, squirt water into the discharging ear. Only the tip of the dropper needs to be in the canal. Without withdrawing the dropper and just by releasing the bulb, suck the water and pus back into the dropper 3. Discard the contents of the dropper into the container for dirty water. Do not squirt the water in and out of the ear. When all the pus has been washed out of the ear, the water sucked back into the dropper is clear 4. Repeat the above steps until there is clean return from the ear 5. Dry the ear canal using tissue spears (see details) Tissue spear method (dry mopping) • This can safely be done by a child on their own or by the parent. It should be done whenever the ear discharges. The tissue paper actively absorbs the moisture • In the management of chronic suppurative otitis media, the tissue spear method should be used in conjunction with regular eye dropper irrigation by the <strong>Health</strong> Care Worker Technique 1. Make a spear by twisting corner of tissue paper 2. Insert into ear gently, twisting slowly 3. Stop when child blinks 4. Leave in place for 30 seconds then remove and repeat until tissue tip is dry 5. Perform at least twice per day until the ear is dry Topical antibiotics and other ear drops with dry mopping • The patient should be sitting or lying down with the affected ear upwards • Clean and dry the ear canal as per dropper method and tissue spears • Instil the ear drops • Apply tragal pressure (pressing several times on the flap of skin in front of ear canal) after the drops have been instilled to assist the drops through the perforation [1] • Keep the patient in position for several minutes • Use of cotton wool as a ‘plug’ just soaks up the medication. Let excess run out 594 Controlled copy V1.0 Primary Clinical Care Manual 2011
Ear problems Ear discharge in the presence of grommets 1. May present with • History of insertion of grommet in one or both ears • Discharge of pus from a grommet, fever, URTI, related to water immersion 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 plus: -- clean the ear using tissue spears until all pus has been removed and the drum and perforation can be seen -- document the size and position of perforation on a diagram in the case notes 4. Management • Consult MO for antibiotic order • Treat as per Acute otitis media with perforation 5. Follow up As per MO instructions Advise no swimming. If this is not possible in a hot tropical climate, ear plugs with a swimming cap for swimming are recommended for children with grommets. Effective ear plugs can be custom built or made from silicon putty, cotton wool with Vaseline, or “Blu-Tack®” 6. Referral / consultation As above Cholesteatoma Recommend Be aware of cholesteatoma when performing all otoscopic examinations Cholesteatoma is treated surgically and success is highly dependent on early recognition and the extent of the lesion Background Most patients who acquire cholesteatomas have a history of recurrent acute otitis media and / or chronic middle-ear perforation Patients with a family history of chronic middle ear disease and / or cholesteatoma are at increased risk [9] Related topics Acute otitis media with perforation Assessment of the ear 1. May present with If diagnosed early may have no symptoms. Otherwise may present with: • Dizziness, ache behind the ear especially at night • Muscle weakness of the face, foul odour from the ear • White mass behind intact ear drum on otoscopic examination • New onset of hearing loss in a previously operated ear • History of chronic perforation of the ear drum Primary Clinical Care Manual 2011 Controlled copy V 1.0 595
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 and 44: Ear problems Schedule 4 Roxithromyc
Page 45 and 46: Ear problems 4. Management • Give
Page 47 and 48: See Simple analgesia back cover Ear
Page 49 and 50: Ear problems 6. Referral / consulta
Page 51: Ear problems 5. Follow up Children
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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