Which modification is recommended when a CF patient on PEP therapy develops a middle ear infection?

Which modification is recommended when a CF patient on PEP therapy develops a middle ear infection?

• A. Continue with reduced resistance
• B. Change to an external percussive device
• C. Administer IPPB with Pulmozyme
• D. Huff coughing instruction

Answer: (B)

The key idea is airway clearance techniques must be adjusted to avoid increasing pressure that could worsen a middle ear infection. Positive expiratory pressure therapy works by maintaining airway pressure to help mobilize mucus, but that same pressure can be transmitted through the Eustachian tube to the middle ear, potentially exacerbating otitis media. Switching to an external percussive device provides chest percussion and vibration to loosen secretions without delivering positive airway pressure, reducing the risk to the middle ear while still aiding mucus clearance. The other options maintain or introduce pressures or techniques that don’t specifically address the ear infection risk, making them less suitable in this scenario.

The key idea is airway clearance techniques must be adjusted to avoid increasing pressure that could worsen a middle ear infection. Positive expiratory pressure therapy works by maintaining airway pressure to help mobilize mucus, but that same pressure can be transmitted through the Eustachian tube to the middle ear, potentially exacerbating otitis media. Switching to an external percussive device provides chest percussion and vibration to loosen secretions without delivering positive airway pressure, reducing the risk to the middle ear while still aiding mucus clearance. The other options maintain or introduce pressures or techniques that don’t specifically address the ear infection risk, making them less suitable in this scenario.