Questions from an Urgent Care doctor

[tasslebury]

Hello! I am an MD and work at a very busy Urgent Care. I was trained in Family Medicine and have some questions for my ENT specialist friends-

1. Any recommended reference for PCPs to quickly look up standard treatment and f/u for ENT conditions?
2. What do you recommend for treatment with otalgia a/w effusion? Also, any necessary f/u or eval by ENT needed?
3. For AOM are you okay with amox 500mg bid or do you prefer tid? Do you add steroids, and if so how much?
4. I've had patients come in with ear pain and normal ear exams only to return 3 days later with a bulging and erythematous TM... is there some way to be catching these earlier?
5. Any change in management for a rupture/bleeding AOM?
6. Does otitis media with effusion always result from eustachian tube dysfunction? Can this occur without a clear precipitant?

Thank you so much!!

[ENTMD]

2. Otalgia without an obvious otologic cause is referred from somewhere else.  So unless you can identify what THAT is, you won't know how to treat this.  3.  I don't recommend steroids for AOM.  I'm not even crazy about routine abx for AOM.  Look at a lot of the more recent, large studies on watchful waiting.  Otherwise, your dosing is going to depend upon weight, if a child.  The does you suggested would be undertreating an adult.  4. I don't know that there is.  5.  If the membrane is ruptured, it would probably be prudent to at a topical (ofloxacin, eg).  6. Ultimately the Eustachian tube is responsible for draining the ear of fluids.  So we typically blame OME on its dysfunction.

[tasslebury]

You're fabulous, thanks again for all your help and insights!