problem if displaced, open,septal hematoma (major error if missed).
if can breathe through both nostrils, not major deformity, then recheck in 4-5 days. Analgesic, cold compress for hours, elevation of head. Warn signs of septal hematoma.

Otitis Media

high-dose Amoxil protocols

80-90 mg/kg/day
7 days for low-risk infants over age two, else 10 days
failure at day 3: Rocephin, augmentin, clindamycin

persistent effusion (serous OM)

Assuming normal language, adequate hearing and behavior ...

< 3 months: wait
> 3 months: 10 day course Ab + "short" course of oral steroid
> 6 months: tympanostomy

recurrent otitis media prophylaxis

Prophylaxis is now out of favor. Preferred methods are treating with onset of URI (selective prophylaxis) or with symptoms.

Xylifresh Gum: chew frequently ($$)
amoxil 20mg/kg qD if use

salivary glands

parotid gland: upper buccal, across from top 2nd molars
sublingual and submandibular: beneath tongue

uvulitis

children: consider H. Flu, r/o epiglottitis (esp if not vaccinated)
adults: viral, r/o angiodema (ACE inhibitors, familial). Sx therapy. No benefit with antibiotic therapy.

Author: John G. Faughnan. The views and opinions expressed in this page are strictly those of the page author. Pages are updated on an irregular schedule; suggestions/fixes are welcome but they may take weeks to years to be incorporated. Anyone may freely link to anything on this site and print any page; no permission is needed for citing, linking, printing, or distributing printed copies.

ENT