I. Otitis Externa外耳炎 A. Description 说明
Inflammation of the external auditory canal, which can occur with or without infection; also known as "swimmer's ear."
外耳道炎症，有无感染均可发生；亦称“游泳耳” B. Assessment 评估
1. Rapid onset of symptoms within 48 hours, symptoms include otalgia, pruritis, fullness, drainage, and impaired hearing.
症状48小时内快速出现；症状包括耳痛、瘙痒、发胀、流脓、听力损伤。
2. A low-grade fever may be present.
可能出现低热
3. Tenderness on manipulation of the pinna and tragus is noted on physical exam.
体检操作耳廓、耳屏时有触痛，
4. May have regional lymphadenopathy.
可能有局部淋巴结肿大 C. Interventions措施
Treatment is indicated with topical antibiotics and may include neomycin with or without polymyxin B or a fluoroquinolone preparation.
治疗采用局部抗生素，可能包括新霉素加或不加多粘菌素B或氟喹诺酮制剂。 II. Allergic Rhinitis 变应性鼻炎 A. Description 说明
A condition in which children are sensitized to environmental allergens.
儿童对环境变应原过敏 B. Assessment 评估
1. Itchy and watery eyes, runny nose, itchy throat.
眼睛痒、流眼泪，流鼻涕、喉咙痒
2. May be a family history of atopic disease.
可能有变应性疾病家族史
3. Dark circles under the eyes, cobblestoning of the conjunctiva, pale nasal mucosa, clear nasal drainage, nasal polyps, fluid in the middle ear, cobblestoning of the posterior pharynx, wheezes, rhonchi, eczema, hives, angioedema.
眼下有暗圈、结膜鹅卵子石样、鼻粘膜苍白、鼻流清涕、鼻息肉、中耳液体、后咽鹅卵子石样、哮鸣、鼾音、湿疹、寻麻疹、血管性水肿。 C. Interventions措施
1. Children with allergic rhinitis should be tested for environmental allergies, food allergies, atopic dermatitis, and asthma.
变应性鼻炎儿童应作环境过敏、食物过敏、特应性皮炎和哮喘检查。
2. Avoidance of triggers;administration of prescribed antihistamines, nasal corticosteroids, inhalers.
避开诱发物质，使用处方的抗组胺药、鼻皮质甾类、吸入器。
★Vocabulary for Today ★
otitis externa -- 外耳炎
external auditory canal –外耳道
swimmer's ear -- 游泳耳
otalgia – n. 耳痛
pruritis – n. 瘙痒
fullness – n. 发胀
pinna – n. 耳廓
tragus – n. 耳屏
neomycin – n. 新霉素
polymyxin B – n. 多粘菌素B
fluoroquinolone – n. 氟喹诺酮
allergic rhinitis -- 变应性鼻炎
runny nose -- 流鼻涕
cobblestoning – n. 鹅卵子石样
polyp – n. 息肉
atopic dermatitis – 特应性皮炎
1. A 39-year-old man with chronic allergic rhinitis and nasal congestion takes an over-the-counter nasal spray containing oxymetazoline. Over the next few days, he has significant improvement in his symptoms. Which of the following is the most likely mechanism of action of this agent?
A. Increased nasal blood flow
B. Increased intranasal arterial pressure
C. Receptor stimulation on nasal vasculature
D. Transmembrane conductance change
2.A 34-year-old man with allergic rhinitis presents to his primary care physician for treatment. He is prescribed diphenhydramine and develops dry eyes and mouth within 2 days. His symptoms of rhinitis are approximately 75% better. He calls his physician asking what he should do. The most appropriate management for this patient is which of the following?
A. Continue medication at current dose
B. Discontinue diphenhydramine
C. Start therapy with chlorpheniramine in addition to diphenhydramine
D. Surgical consultation for rhinoplasty
答案 Key to Questions 1. C: Receptor stimulation on nasal vasculature.
Oxymetazoline is found in many over-the-counter short-term nasal spray decongestant products (applied every 12 h) as well as in ophthalmic drops for the relief of redness of the eyes associated with swimming, colds, and contact lenses. The mechanism of action of oxymetazoline is direct stimulation of receptors on blood vessels supplying the nasal mucosa and the conjunctiva to reduce blood flow and decrease congestion. Oxymetazoline is absorbed in the systemic circulation regardless of the route of administration and may produce nervousness, headaches, and trouble sleeping. 2. A: Continue medication at current dose.
In general, anticholinergic side effects of the first-generation antihistamines, such as diphenhydramine (dry eyes/mouth, difficulty urinating and/or defecating) are transient and may resolve in 7 to 10 days. Constipation associated with chronic use of the firstgeneration antihistamines is not transient and may require treatment with a stool softener, especially in more susceptible patients.
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