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IPE Project: Case 7 - Otitis Media

Krishna Patel, Kayla Copas

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PA

Take medical history
Perform physical exam
Order and interpret laboratory studies
Diagnose illness
Develop and manage treatment plans
Prescribe medications
Assist in surgery

PT¹

Patient/ Client Management
Optimize physical function, movement, performance, health, and quality of life across the lifespan.

Scope of Practice

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Storyline

5 month old male dx with CMT.
Goes to PA for recurrent bilateral ear infections despite abx treatment.
Also presents with a head “tilt” onset 2 months that changes sides.
Symptoms began after starting daycare 2 months ago.
No decreased passive or active cervical ROM
Cervical sidebending is a 2/5 on the Muscle Function Scale

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Original Diagnosis

Congenital Muscular Torticollis

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New Diagnosis

Otitis media w/ effusion

Ear infections in kids can be common due to undeveloped sinuses

Cervical muscle weakness

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Treatment Plan

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Physician Assistant

History Taking:

What antibiotics has John tried?
Has he been able to take the medication properly and complete the whole regimen?
Have you noticed John pulling or touching either ear more frequently?
Have you noticed if anything makes the pain worse or better?

Physical Exam:

Erythema
Effusion
Bulging
Discharge
Fever
Fussiness

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Physician Assistant

Medications

Amoxicillin (mainstay)
Augmentin if resistant
Penicillin G Benzathine IM

Holistic Treatment

Warm compresses
Keep head elevated
Hydration

Testing

Tympanometry

Referral

Physical therapy for the head tilt
Pediatric ENT for testing

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Physical Therapy

Referral for cervical muscle weakness

Reassess Muscle Function Test

PDMS-2

Assess fine and gross motor skills

Reflex Testing

Neck Righting/Body Righting
Labyrinth and Optical Righting
Moro Reflex
ATNR
Babinski

Other Testing

Assess for nystagmus in different positions
Eye tracking
Eyes crossing midline
Hearing

Muscle Function Test upon initial eval is 2 out of 5 bilaterally. These results are not consistent with CMT given that they are the same bilaterally. A 2 out of 5 would mean that the baby is only able to hold is head slightly over the horizontal line. This would be indicative of cervical muscle weakness.

Assess for intact reflexes to rule out any neurological abnormalities. He may or may not still have neck and body righting since it integrates between 4-6 months. Labyrinth and optical righting should be integrated by 2 months. ATNR should be integrated by 3 months. Moro may or may not be present since it integrates between 4-6 months. Babinski will most likely be present since it integrates around 2 years old.

Other testing would also be performed to see if maybe the baby was having these issues due to some other vestibular abnormality. These persistent infections could also cause changes in his vestibular system.

5. Costa J, Goodman M. (2020). Primitive Reflexes and Balance Reactions. [PowerPoint Presentation] (Accessed: October 13, 2021)

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Physical Therapy

Interventions

Developmental Milestones

Head control in supported sitting
Head lag with pull to sit
Head control in supported standing

Cervical muscle strengthening

Play in “tummy time”
Work on crossing midline

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Pediatric ENT

Testing

Hearing test
Long periods of decreased hearing in young children can lead to delays in speech development

Treatment

Myringotomy & tympanostomy

If ear infections don’t clear up easily
Ear infections cause hearing loss or speech delay

Referral

Speech pathologist

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References

Apta.org. 2021. [online] Available at: <https://www.apta.org/contentassets/a400d547ca63438db1349c4a69bf7ead/position-pt-scope-practice.pdf> [Accessed 26 October 2021].
Pa scope of practice - home - AAPA. https://www.aapa.org/wp-content/uploads/2017/01/Issue-brief_Scope-of-Practice_0117-1.pdf. Accessed November 1, 2021.
Inverso D, ed. Hearing tests (for parents) - nemours kidshealth. KidsHealth. https://kidshealth.org/en/parents/hear.html. Accessed November 2, 2021.
Barth PC, ed. Ear Tube Surgery (for parents) - nemours kidshealth. KidsHealth. https://kidshealth.org/en/parents/ear-infections.html. Published June 2019. Accessed November 2, 2021.
Costa J, Goodman M. (2020). Primitive Reflexes and Balance Reactions. [PowerPoint Presentation] (Accessed: October 13, 2021).
Costa J, Goodman M. (2020). Motor Development: 4-6 months. [PowerPoint Presentation]. (Accessed: October 13, 2021).
Huston K. Kids are more likely to get an ear infection - how to spot it and what to do. Norton Children's. https://nortonchildrens.com/news/middle-ear-infection-symptoms-in-kids/. Published July 31, 2020. Accessed November 3, 2021.
Biondolillo F. Ear, Nose, Sinuses, & Eye Intro. lecture presented at the: Pathology & Clinical Medicine; October 18, 2021.
Tympanostomy tube insertion. MedBroadcast.com. https://www.medbroadcast.com/procedure/getprocedure/tympanostomy-tube-insertion. Accessed November 3, 2021.