Clinical Correlates: Hay Fever and Otitis Media
The case is called "A Red Eardrum followed by a Red Eye"
The questions I am to answer for this case:
What is hay fever and how might that be related to the development of otitis media? What health conditions might increase the risk of developing recurrent or chronic otitis media? What environmental factors may serve to increase the risk for the development of otitis media?
HAY FEVER
= allergic rhinitis of the seasonal variety
--occurs when plants are blossoming
--caused by pollens of specific seasonal plants, airborne chemicals and dust particles in people w/ allergy
--or according to Zwickey, caused by dust mite feces on pollen which contain the necessary small soluble protein in the form of a proteinase, on a dessicated particle and occuring in low doses
--characterised by sneezing, runny nose and itching eyes
--according to Brons, the pterygopalatine ganglion is the "hayfever ganglion". It is located on the Facial nerve (CN VII) pathway from the superior salivatory nuclei (GVE, general visceral efferent) to the nasal mucosa, palatine and lacrimal glands
--Th2 response-->IL-13-->mucus-->stops up Eustacian tube-->medium for infx
HEALTH CONDITIONS THAT INCREASE THE RISK OF RECURRENT OR CHRONIC OTITIS MEDIA:
--any allergic condition
--diabetes
--sinusitis
--poor Eustacian tube function, may be genetic
--down syndrome
--cri du chat syndrome = missing a piece of chromosome #5, child has high pitched cry like cat, slanted eyes, low birth weight, slow growth, low & abnormal ears, mental retardation, partial webbing or fusing of fingers or toes, wide-set eyes & a variety of facial abnormalities, microcephaly
--cleft lip, cleft palate
--choanal atresia = a congenital anomaly of the anterior skull base characterized by closure of one or both posterior nasal cavities, occurs in 1:7,000-8,000 live births.
--microcephaly from any cause
OTHER:
--being a child: eustachian tube is shorter and straighter than in the adult, also adenoids in children are larger than they are in adults, can interfere with eustachian tube opening
--being male, black or hispanic
ENVIRONMENTAL FACTORS THAT INCREASE THE SAME RISK:
--exposure to high pollen counts, spending time outside, wearing clothing that was dried outside, mowing grass, working outdoors, bicycle commuting
--living in a city, higher particulates in air
--dust, wind, dirt roads
--cigarette smoke, first or second hand
--other smoke: forest fires etc.
--chlorine, detergents, perfumes, anything in the air
--moist environment
--daycare, group care setting or out of home care by an unrelated sitter
--nursing from a bottle while lying down
--swimming or bathing
OTITIS MEDIA
= inflammation of the middle ear
--between the ear drum and the inner ear, including the Eustachian tube
--the other kind of ear infx is otitis externa
--common in childhood, usu w/ viral URI, ie: the common cold-->serous exudate
--can be bacterial or 2ndary bacterial-->purulent exudate
--bacterial culprits (common): Streptococcus pneumoniae, Moraxella catarrhalis, and rarely: Mycobacterium tuberculosis, Enterica bacilli (per Liz C). Haemophilus influenzae infx used to be common but has been reduced by vaccination.
--common culprit of chronic infx: Staphylococcus aureus, a fungus, Pseudomonas aeruginosa (Liz Collins said P. aeru primarly causes otitis externa).
--rhinoviruses or bacteria go thru Eustachian tube, from back of nose to middle ear-->tube swells shut and pressures can't be equalized-->feeling of head about to pop
--complications: can damage middle ear (ossicles, ear drum), cholesteatoma, aural polyps, mastoiditis (infx in the hollow spaces inside the mastoid process of the temporal bone), and very rare penetrate into the brain-->meningitis
--infections in face and ear can spread easily to eyes etc. via the venous system of the face which is full of anastomoses and is entirely valveless
--recurrent = 3x/6mo or 4+x/year
Tx:
--usually resolves on its own, general support
--vit C
--wait 3-4 days before considering antibiotics, they often do not work due to multiple infecting orgs and drug resistance, amoxicillin is most often used and causes a rash in many children, rash is mild and will subside on its own
--consider homeopathics: medhorrinum (sp?)(a nosode of gonorrhea) and calcarea carbonica were discussed, avoid tylenol etc if attempting homeopathics
--investigate food allergies in child: 80% of kids with chronic otitis media have food allergies and leaky gut
--for leaky gut: avoid NSAIDS, carbs, corticosteroids, oral hormones, chems, fermented food, consider anti-inflammatory diet
The questions I am to answer for this case:
What is hay fever and how might that be related to the development of otitis media? What health conditions might increase the risk of developing recurrent or chronic otitis media? What environmental factors may serve to increase the risk for the development of otitis media?
HAY FEVER
= allergic rhinitis of the seasonal variety
--occurs when plants are blossoming
--caused by pollens of specific seasonal plants, airborne chemicals and dust particles in people w/ allergy
--or according to Zwickey, caused by dust mite feces on pollen which contain the necessary small soluble protein in the form of a proteinase, on a dessicated particle and occuring in low doses
--characterised by sneezing, runny nose and itching eyes
--according to Brons, the pterygopalatine ganglion is the "hayfever ganglion". It is located on the Facial nerve (CN VII) pathway from the superior salivatory nuclei (GVE, general visceral efferent) to the nasal mucosa, palatine and lacrimal glands
--Th2 response-->IL-13-->mucus-->stops up Eustacian tube-->medium for infx
HEALTH CONDITIONS THAT INCREASE THE RISK OF RECURRENT OR CHRONIC OTITIS MEDIA:
--any allergic condition
--diabetes
--sinusitis
--poor Eustacian tube function, may be genetic
--down syndrome
--cri du chat syndrome = missing a piece of chromosome #5, child has high pitched cry like cat, slanted eyes, low birth weight, slow growth, low & abnormal ears, mental retardation, partial webbing or fusing of fingers or toes, wide-set eyes & a variety of facial abnormalities, microcephaly
--cleft lip, cleft palate
--choanal atresia = a congenital anomaly of the anterior skull base characterized by closure of one or both posterior nasal cavities, occurs in 1:7,000-8,000 live births.
--microcephaly from any cause
OTHER:
--being a child: eustachian tube is shorter and straighter than in the adult, also adenoids in children are larger than they are in adults, can interfere with eustachian tube opening
--being male, black or hispanic
ENVIRONMENTAL FACTORS THAT INCREASE THE SAME RISK:
--exposure to high pollen counts, spending time outside, wearing clothing that was dried outside, mowing grass, working outdoors, bicycle commuting
--living in a city, higher particulates in air
--dust, wind, dirt roads
--cigarette smoke, first or second hand
--other smoke: forest fires etc.
--chlorine, detergents, perfumes, anything in the air
--moist environment
--daycare, group care setting or out of home care by an unrelated sitter
--nursing from a bottle while lying down
--swimming or bathing
OTITIS MEDIA
= inflammation of the middle ear
--between the ear drum and the inner ear, including the Eustachian tube
--the other kind of ear infx is otitis externa
--common in childhood, usu w/ viral URI, ie: the common cold-->serous exudate
--can be bacterial or 2ndary bacterial-->purulent exudate
--bacterial culprits (common): Streptococcus pneumoniae, Moraxella catarrhalis, and rarely: Mycobacterium tuberculosis, Enterica bacilli (per Liz C). Haemophilus influenzae infx used to be common but has been reduced by vaccination.
--common culprit of chronic infx: Staphylococcus aureus, a fungus, Pseudomonas aeruginosa (Liz Collins said P. aeru primarly causes otitis externa).
--rhinoviruses or bacteria go thru Eustachian tube, from back of nose to middle ear-->tube swells shut and pressures can't be equalized-->feeling of head about to pop
--complications: can damage middle ear (ossicles, ear drum), cholesteatoma, aural polyps, mastoiditis (infx in the hollow spaces inside the mastoid process of the temporal bone), and very rare penetrate into the brain-->meningitis
--infections in face and ear can spread easily to eyes etc. via the venous system of the face which is full of anastomoses and is entirely valveless
--recurrent = 3x/6mo or 4+x/year
Tx:
--usually resolves on its own, general support
--vit C
--wait 3-4 days before considering antibiotics, they often do not work due to multiple infecting orgs and drug resistance, amoxicillin is most often used and causes a rash in many children, rash is mild and will subside on its own
--consider homeopathics: medhorrinum (sp?)(a nosode of gonorrhea) and calcarea carbonica were discussed, avoid tylenol etc if attempting homeopathics
--investigate food allergies in child: 80% of kids with chronic otitis media have food allergies and leaky gut
--for leaky gut: avoid NSAIDS, carbs, corticosteroids, oral hormones, chems, fermented food, consider anti-inflammatory diet