Diagnosis AMP Examine ear with Otoscope (Physical Exam-9) and report findings to (blue) Surgeon.
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1 Page 1 of 8 pages NOTE Contact Surgeon before giving any medication marked with an asterisk. In an emergency or during Loss of Signal, begin appropriate treatment; then call Surgeon as soon as possible. CONGESTION: SEROUS OTITIS MEDIA Symptoms Decreased hearing Feeling of fullness in ear Pain Inability to clear ear Signs Dull/retracted eardrum Bubbles behind eardrum Diagnosis Examine ear with Otoscope (Physical Exam-9) and report findings to Surgeon. Treatment 1. Decongestants 1. Sudafed has a more rapid onset of effect and is shorter acting than Entex LA. It is a simple and effective decongestant, and may be used prior to any pressure changes (such as EVA) after consultation with Surgeon. Sudafed s main possible side effects are rapid heart rate and jitteriness. 2. Entex LA contains a decongestant and a medication to loosen secretions. Entex LA is longer acting and mild and is a good choice for mild but persistent symptoms. Entex LA s main possible side effects include restlessness and nervousness. 3. Use Afrin Nasal Spray, especially for nose and inner ear congestion. This is also good to use if mildly congested and pressure changes are anticipated. Generally, use two sprays each dose. Do not use more than 3 days. Sudafed (Pseudoephedrine) (P1-B16)
2 Page 2 of 8 pages Entex LA (Phenylpropanolamine/Guaifenesin) (P1-B14,15) Dose: 1 tablet every 12 hours as needed Insomnia, restlessness, headache, nausea Afrin Nasal Spray (P2-B1) - Long-acting topical nasal decongestant Dose: 1-2 sprays in each nostril every 12 hours as needed Burning, stinging, sneezing, or increased nasal discharge Usage more frequently than directed can produce chronic nasal congestion. Perform gentle Valsalva times/day.
3 Page 3 of 8 pages INTERNAL INFECTION: OTITIS MEDIA Symptoms Pain Sensation of warmth Decreased hearing in affected ear Signs Red and bulging eardrum (Tympanic membrane) No normal landmarks Fever Diagnosis Examine ear using Otoscope ( Physical Exam-9). Treatment 1. Contact Surgeon. 2. Antibiotics Both Amoxicillin and Bactrim are generally effective for otitis media (middle ear infection) and serious side effects are uncommon. Selection depends on individual experience and known allergies or sensitivities. It is best to check with Surgeon before selecting. Amoxicillin (Amoxil) (P1-A13,14,15) Dose: 1 capsule every 8 hours for 10 days WARNING Do not use if there is history of Penicillin or Cephalosporin allergy. Nausea, diarrhea, rash
4 Page 4 of 8 pages Bactrim DS (Trimethoprim/Sulfamethoxasole) (P1-A4,5) Dose: 1 tablet every 12 hours for 10 days WARNING Do not use if allergy to sulfa or trimethoprim exists. Skin rash, headache, stomach upset 3. Decongestants 1. Sudafed has a more rapid onset of effect and is shorter acting than Entex LA. It is a simple and effective decongestant, and may be used prior to any pressure changes (such as EVA) after consultation with Surgeon. Sudafed s main possible side effects are rapid heart rate and jitteriness. 2. Entex LA contains a decongestant and a medication to loosen secretions. Entex LA is longer acting and milder, and is a good choice for mild but persistent symptoms. Entex LA s main possible side effects include restlessness and nervousness. Sudafed (Pseudoephedrine) (P1-B16) Entex LA (Phenylpropanolamine/Guaifenesin) (P1-B14,15) Dose: 1 tablet every 12 hours as needed Insomnia, restlessness, headache, nausea
5 Page 5 of 8 pages 4. Pain Medications 1. Ascriptin (buffered aspirin) is an anti-inflammatory and analgesic agent. It may cause mild upset stomach and should be avoided if there is allergy to aspirin. 2. Tylenol is analgesic but not anti-inflammatory and does not cause upset stomach or other serious side effects. Tylenol works as well as Ascriptin. 3. Ascriptin and Tylenol also reduce fever. Ascriptin (Aspirin) (P1-B1,2) - Pain reliever, anti-inflammatory NOTE Do not use in patients with asthma, history of aspirin allergy, GI, or other bleeding problems. Possible side effects include upset stomach and ringing in ears. Tylenol (Acetaminophen) (P1-A1,2,3) - Aspirin-free pain reliever
6 Page 6 of 8 pages EAR CANAL INFECTION: EXTERNAL OTITIS Symptoms Pain in affected ear Signs Redness on surface of ear canal Pus in external ear canal Swelling Tenderness when pulling on external ear WARNING Do not use ear drops or Pope otowick if ruptured eardrum is seen or suspected. Diagnosis Examine ear with Otoscope (Physical Exam-9), and Speculum (Physical Exam-3). Treatment 1. Insert Pope Otowick (P3-B1) in affected ear canal with Forceps (Surgical Supply-2). 2. Saturate Pope Otowick with Cortisporin Ophthalmic (for eyes or ears) Solution (P2-A2) until fully expanded in ear canal. Repeat saturation 4 times/day. 3. Pain Medications 1. Ascriptin (buffered aspirin) is an anti-inflammatory and analgesic agent. It may cause mild upset stomach and should be avoided if there is allergy to aspirin. 2. Tylenol is analgesic but not anti-inflammatory and does not cause upset stomach or other serious side effects. Tylenol works as well as Ascriptin. 3. Ascriptin and Tylenol also reduce fever. Ascriptin (Aspirin) (P1-B1,2) - Pain reliever, anti-inflammatory
7 Page 7 of 8 pages NOTE Do not use in patients with asthma, history of aspirin allergy, or GI or other bleeding problems. Possible side effects include upset stomach and ringing in ears. Tylenol (Acetaminophen) (P1-A1,2,3) - Aspirin-free pain reliever
8 Page 8 of 8 pages EAR/SINUS BLOCK NOTE Symptoms may occur during recompression from EVA. Symptoms Ear pain Inability to clear middle ear Loss of hearing acuity Sinus and facial pain Management 1. Stop recompression, gently attempt equalization of pressure in middle ear. 2. If unsuccessful or sinus pain present, depressurize airlock until symptoms relieved (if possible), then slowly recompress. 3. If pain persists after complete recompression, examine ear with Otoscope (Physical Exam-9). 4. Use Afrin Nasal Spray (P2-B1) - Long-acting topical nasal decongestant Dose: 1-2 sprays in each nostril Burning, stinging, sneezing, or increased nasal discharge Usage more frequently than directed can produce chronic nasal congestion. 5. Contact Surgeon and report exam findings.
CAUSES Pressure changes Respiratory infection-congestion or sinus infection
Page 1 of 6 pages NOTE Contact Surgeon before giving any medication marked with an asterisk. In an emergency or during Loss of Signal, begin appropriate treatment; then call Surgeon as soon as possible.
MILD TO MODERATE NOTE Medication is listed in increasing order of strength. Ascriptin (Aspirin) (P1-B1,2) - Pain reliever, anti-inflammatory
Page 1 of 6 pages Contact Surgeon before giving any medication marked with an asterisk. In an emergency or during Loss of Signal, begin appropriate treatment; then call Surgeon as soon as possible. MILD
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