Approach To Otitis Externa Flashcards
What is otitis externa?
Inflammation of the outer ear canal
What does PSPP Stand for?
Primary, Seconday, Presdisposing, Perpetuating
What bacteria do we need to be worried about with secondary causes?
Pseudomonas aeruginosa
What are some examples of predisposing causes?
Conformation
Humidity
Inappropriate cleaning
Irritant treatments
Obstructive ear disease
What are some of the examples of perpetuating causes?
Inflammation
Impaired self cleaning
Narrowed lumen
Ulceration and oedema of ear canal
Connective tissue calcification
Tympanic membrane inflammation
How would you treat allergic dermatitis?
Identify the allergy
Clean ears
Treat the secondary infection
How would you treat a foreign body
Sedate or GA and remove
Irrigate and flush ear
Medication as needed
How would you treat immune mediated dermatitis?
Corticosteroids
May also need to treat any secondary problems
What is the function of corticosteroids?
Reduces inflammation in acute otitis externa
Limits the pathological process in chronic OE
Addresses pain
What is the purpose of ear cleaning?
Aids in examination
Removes wax harbouring microbes
Breaks up the biofilm
What is the most common ear cleaning treatment?
- Ceruminolytics
- Astringents
- Antimicrobial agents
- Honey?
What is TrizEDTA?
Disrupts the biofilm
Damages bacterial cell walls
non ototoxic
can be co-administered
When would you do ear flushing?
- May be neccesary in initial OE therapy
- Performed under GA
- Visualise with a video-otoscope
- Use a spruelle needle
- Use sterile saline
What are the benefits of the ear cleaning?
Reduces microbial load
Cleans the ear canal of debris and allows better penetration
allows better visualisation of the ear canal
What is photodynamic therapy?
Uses porphyrins as photosensitising molecules- organisms are sesnitised by uptake of porphyrins and destroyed on exposure to white light
What are the three surgeries you may do for ear issues?
- Lateral wall resection
- Vertical canal ablation
- Total ear canal ablation
What is the follow up examination for otitis externa?
Usually need first visit after 3 days of oral cortisone
Re-evaluate 7-10 days once on topical treatment
Continue treatment until the primary causes are resolved or controlled
What topical treatment should you use if the cytology is rods?
- Framycetin, Gentamicin, Polymyxin B
What topical treatment should you use if the cytology in otitis externa is cocci?
Florfenicol, Fusidic acid/framycetin/Polymyxin B/miconazole
can combine with an antiseptic ear cleaner
What is the function of TrizEDTA?
- Disrupts the biofilm
- damages bacterial cell walls
- non ototoxic
- best given 20-30 minutes before other products
- can also be co-administered
What is the function of ear flushing?
May be necessary in initial OE therapy * Performed under GA
* Visualise with video-otoscope/otoscope
* Using a Spruelle needle /urinary catheter/nasogastric feeding tube, flush and aspirate fluid * Use sterile saline (or dilute chlorhexidine solution)
What are the benefits of ear flushing?
Reduces microbial load
* Clears ear canal of debris and allows better penetration of topical drugs
* Affords better visualisation of ear canal –
helps to ensure nothing is missed and allows assessment of the TMF
What is the effec of a lateral wall resection?
- Improves drainage
- gained access to polyps/ neoplastic lesions
When would you do a vertical canal ablation?
- Irreversible disease of vertical canal
(unlikely scenario – likely to fail)
