50. diseases of the external ear

Question 1

what to mention

Answer 1

etiology: all different factors
steps of physical exam
cleaning ear
types of OE

Question 2

etiology- types of factors

Answer 2

primary factors
secondary factors
predisposing factors
perpetuating factors

Question 3

what are primary factors

Answer 3

things that directly cause OE
atopy, food allergy, contact allergy
parasites, foreign body
autoimmune

Question 4

what are secondary factors

Answer 4

dont cause infection in healthy ear alone

bacteria, yeast, overcleaning

Question 5

what are predisposing factors

Answer 5

alter ear canal - increase susceptibility
narrow, pendulous ear
frequent bathing and swimming
increased amount of soft tissue or hair

Question 6

what are the perpetuating factors

Answer 6

consecuences of OE - maintain inflammation

edema, fibrosis, ulcer, thick skin

Question 7

what are the steps of physical exam

Answer 7

1 skin of concave pinna 
2 width, length of canal 
3 amount and quality of discharge 
4 skin of canal 
5 sensitivity upon palpation 
6 state of tympanic membrane

Question 8

why is cleaning of ear important, and what can we use

Answer 8

closer examination in clean ear
drugs work better 
cerumenolytics: squalene
drying agent: boric acid, salicylic acid 
disinfectants: chlorhexidine, tris EDTA

Question 9

what types of OE do we have

Answer 9

bacterial
malassezia
parasitic 
foreign body
masses

Question 10

bacterial OE pathogens

Answer 10

secondary factor
staphylococci, streptococci
pseudomonas, e coli..

Question 11

bacterial OE examination

Answer 11

1. CONCAVE SURFACE OF THE EAR:
   erythematous, may be dried pus visible
2. WIDTH AND LENGTH OF THE EAR: slight narrowing
3. AMOUNT AND QUALITY OF DISCHARGE: medium - large amount of pus like discharge
4. SKIN OF THE EAR: erythematous inflammation, red, bleed
5. SENSITIVITY: increased painful
6. TM: intact

Question 12

bacterial OE pseudomonas

Answer 12

1. CONCAVE SURFACE OF THE EAR: red, dry, brownish content, smell like wet leaf
2. WIDTH AND LENGTH OF THE EAR: mild narrowing
3. AMOUNT AND QUALITY OF DISCHARGE: creamy brown content
4. SKIN OF THE EAR: inflamed, bleeding ulcer, micro abscesses
5. SENSITIVITY: increased pain
6. TM: intact, but pseudomonas can migrate through

Question 13

bacterial OE treatment

Answer 13

cleaning, disinfection
AB- based on cytology
chloramphenicol, florphenicol - staph strep
marbofloxacin - ONLY pseudomonas!

Question 14

mallasseziosis

Answer 14

1. CONCAVE SURFACE OF THE EAR: thick, wrinkled, red/brown discharge
2. WIDTH AND LENGTH OF THE EAR: mild - severe narrowing
3. AMOUNT AND QUALITY OF DISCHARGE: brown, smelly, mud-like
4. SKIN OF THE EAR: inflamed, cobble stone pattern
5. SENSITIVITY: painful
6. TM: intact

Question 15

malasseziosis treatment

Answer 15

claenaing, cerumenolytic
antimycotic - cytology, not always needed for successful treatment
antiinflammatory depend on level of dermatitis

Question 16

parasitic OE pathogen

Answer 16

otodectes cynosis - ear mites

ZOONOSIS

Question 17

parasitic OE examination

Answer 17

1. CONCAVE SURFACE OF THE EAR: look intact, but black crustous content
2. WIDTH AND LENGTH OF THE EAR: normal
3. AMOUNT AND QUALITY OF DISCHARGE: black, brown coffee like
4. SKIN OF THE EAR: red, inflamed
5. SENSITIVITY: very painful
6. TM: intact

Question 18

parasitic OE treatment

Answer 18

cleaning - cerumenolytics

topical: thiabendazole
systemic: selamectin

Question 19

foreign body OE

Answer 19

1. CONCAVE SURFACE OF THE EAR: normal
2. WIDTH AND LENGTH OF THE EAR: normal
3. AMOUNT AND QUALITY OF DISCHARGE: blood/debris/pus
4. SKIN OF THE EAR: intact or damaged, inflamed
5. SENSITIVITY: painful
6. TM: depend on location of foreign body

Question 20

masses in OE

Answer 20

diff between cat and dog
dog: papilloma
cat: polyps
always CT to know the true size of it