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A - MSRA ENT [6] > [11] Otitis Externa > Flashcards

[11] Otitis Externa Flashcards

1
Q

What is otitis externa?

A

Inflammation of the outer ear

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2
Q

What does otitis externa include?

A

Inflammatory conditions of the auricle, external auditory canal and outer surface of the ear drum

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3
Q

How can otitis externa vary?

A

Can be local or diffuse and acute or chronic

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4
Q

How is the ear canal kept clean?

A

It is self cleaning and clears itself of debris

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5
Q

How is the ear canal self-cleaning?

A

Epithelial migration - the skin surface moves laterally from the tympanic membrane towards the ear canal opening

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6
Q

What is ear wax also known as?

A

Cerumen

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7
Q

What does ear wax consist of?

A
  • Epithelial cells
  • Lysozymes
  • Oily secretions
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8
Q

What is the role of ear wax?

A
  • Cleaning
  • Lubrication
  • Protection
  • Inhibition of bacterial and fungal growth
  • Prevent water from from reaching the canal skin
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9
Q

What can ear wax protect the canal from?

A

Bacteria, dust and insects

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10
Q

How does ear wax inhibit the growth of bacteria and fungi?

A

Creates an acidic coat

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11
Q

How does ear wax prevent water from reaching the canal skin?

A

It has hydrophobic properties

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12
Q

Besides wax, what helps to protect the outer part of the ear canal?

A

Hair

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13
Q

What is the role of the hair in the outer part of the ear canal?

A

Prevent objects entering and aid desquamation and skin migration

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14
Q

What is the underlying pathology of otitis externa?

A

Disturbance of the lipid/acid balance of the ear canal

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15
Q

What is the most common cause of otitis externa?

A

Infection

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16
Q

What are other potential causes of otitis externa?

A
  • Allergy
  • Irritation
  • Inflammatory conditions
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17
Q

Bacteria is responsible for what percentage of infective cases of otitis externa?

A

90%

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18
Q

Fungi is responsible for what percentage of infective cases of otitis externa?

A

10%

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19
Q

Is bacterial otitis externa usually caused by a single organism?

A

No, most have multiple organisms involved

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20
Q

What are the most common bacteria involved in otitis externa?

A

S. aureus and P. aeruginosa

21
Q

What virus can cause otitis externa?

A

Herpes zoster

22
Q

What is an outer ear herpes zoster infection known as?

A

Ramsay Hunt Syndrome

23
Q

What causes of skin inflammation can cause otitis externa?

A
  • Seborrhoeic dermatitis
  • Acne
  • Psoriasis
  • Atopic eczema
  • SLE
24
Q

What irritants can cause otitis externa?

A
  • Topical medications
  • Hearing aids
  • Earplugs
  • Ear trauma from foreign bodies
  • Water in ear
  • Chemicals e.g. hair spray/dye
25
Q

What are the risk factors for otitis externa?

A
  • Hot and humid climate
  • Swimming
  • Old age
  • Immunocompromised
  • DM
  • Narrow external auditory meatus
  • Obstruction of normal meatus
  • Insufficient wax
  • Wax build up
  • Dermatological conditions
  • Trauma to the ear canal
26
Q

What can cause a narrow external auditory meatus?

A
  • Hereditary

- Chronic infection

27
Q

What can cause obstruction of a normal external auditory meatus?

A
  • Keratosis obturans
  • Foreign body
  • Hearing aid
  • Hirsute ear canal
28
Q

What can often lead to insufficient ear wax?

A

Over-cleaning

29
Q

Why can wax-build up lead to otitis externa?

A

Causes obstruction and retention of water, debris and infectious organisms

30
Q

What dermatological conditions can increase the risk of otitis externa?

A
  • Eczema
  • Seborrhoeic dermatitis
  • Allergic, atopic or irritant dermatitis affecting the ear canal
31
Q

What trauma to the ear canal can increase the risk of otitis externa?

A
  • Cotton bud use

- Radiotherapy

32
Q

What are the main symptoms of otitis externa?

A
  • Pain
  • Itching
  • Discharge
  • Hearing loss
33
Q

What may be seen on examination in otitis externa?

A
  • Erythem, oedem and exudate in canal
  • Mobile tympanic membrane
  • Pain on moving tragus or auricle
  • Periauricular lymphadenopathy
34
Q

What are the signs of more severe otitis externa?

A
  • Narrowed and obscured ear canal
  • Hearing loss
  • Discharge
  • Regional lymphadenopathy
  • Cellulitis beyond ear
  • Fever
35
Q

When are swabs recommended in otitis externa?

A

If treatment has failed or the presentation is atypical

36
Q

Where is the swab in otitis externa best taken from to avoid contamination?

A

The medial aspect of the ear canal under visualisation

37
Q

What are the differentials for otitis externa?

A
  • Foreign bodies
  • Impacted wax
  • Otitis media
  • Cholesteatoma
  • Referred pain from sphenoid sinus, teeth, neck, or throat
  • Barotrauma
  • Dermatological disease
38
Q

What is the aim of treatment in otitis externa?

A
  • Settle symptoms
  • Cure infection
  • Reduce risk of recurrence
  • Prevent complications
39
Q

What is the most common treatment method for otitis externa?

A

Topical drops

40
Q

What other treatment methods can be useful in otitis externa?

A

Wicking and removal of debris

41
Q

What should you do if initial treatment of otitis externa fails?

A

Reconsider diagnosis

42
Q

When are oral antibiotics indicated in the management of otitis externa?

A

If there is cellulitis or cervical lymphadenopathy

43
Q

What do patients with systemic symptoms in otitis externa need?

A

Same-day ENT review and potentially admission for IV antibiotics

44
Q

What is chronic otitis externa?

A

When it is present for > 3 months

45
Q

How is chronic otitis externa primarily treated?

A

Identifying the underlying cause and removing it

46
Q

What should be done if there is no identifiable cause of chronic otitis externa?

A

7 days of acetic acid 2% drops with corticosteroid drops

47
Q

If fungal growth is suspected to be the cause of chronic otitis externa what should be prescribed?

A

Topical antifungal

48
Q

What are the potential complications of otitis externa?

A
  • Temporary hearing loss
  • Acute otitis externa becomes chronic
  • Cellulitis
  • Necrotising otitis externa

A - MSRA ENT [6] (22 decks)

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