Approach To Otorrhea and Otalgia Flashcards
acute vs chronic onset
acute <4 wks
chronic >12 wks
middle ear lining vs external ear lining
middle: ciliated cuboidal epithelium (secretory), discharge is mucopurulent (like nose)
external: ssqe (like skin), discharge is serous/ watery/ scanty mucoid/ purulent if with pustule
choleasteatoma forms in the ___ quadrants
superior quadrants
also known as swimmer’s ear or tropical ear and involves rapid onset (<48 h) of signs and symptoms of ear canal inflammation
acute otitis externa
how does swimming affect the ear
water exposure changes ph, makes it basic (should be acidic)
etiology of acute otitis externa
pseudomonas aeruginosa!!
staph epidermidis
s aureus
symptoms of acute otitis externa
- moderate to severe otalgia worsened by manipulation of pinna (tragal tenderness)
- swollen, edematous, erythematous with scanty serous/purulent discharge
treatment of acute otitis externa
topical: polymyxin B + neomycin + dexamethasone / flucinolone, ciprofloxacin + dexamethasone
aural toilet, wick to deliver drug
oral antibiotics are effective in acute otitis externa treatment
false
what is otomycosis
- cc: ear pruritus and/or pain
- onset: chronic or acute
- etiology: aspergillus or candida
treatment of otomycosis
- debridement / aural toilet
- topical antifungal: clotrimazole +/- beclomethasone, tolnaftate, vinegar + 70% isopropyl alcohol
classically known as “malignant otitis externa”
necrotizing otitis externa
etiology of necrotizing otitis externa
p aeruginosa s aureus s epidermidis proteus mirabilis hiv: aspergillus fumigatus
clinical manifestations of necrotizing otitis externa
- long standing otalgia
- involves cn 7-11
- life threatening
risk factors for necrotizing otitis externa
- patient with glucose intolerance (DM)
- pharmagologic immunosuppression
- hiv +
- myeloid malignancies
diagnostics for necrotizing otitis externa
- ct scan / mri
- technetium scan 99
- radioisotope scans (monitoring)
- esr: elevated
treatment for necrotizing otitis externa
early: ciprofloxacin po
advanced: parenteral for >6 wks or until esr is normal or normal gallium scan
fungal: amphotericin b, itraconazole, voriconazole
what is external auditory canal or temporal bone malignancy
- squamous cell carcinoma
- common in old age group
- presentation: eac mass with chronic history of bloody diarrhea
- treatment: surgery + radio +/- chemo
vzv infection of auricle and eac
herpes zoster oticus
hxo + cn 7 paralysis = ___
ramsay hunt syndrome
clinical presentation of hzo
- prodrome: otalgia (unrelieved severe burning)
- vesicular eruption in concha and/or eac
- facial nerve paralysis or palsy
- dysgeusia (chorda tympani)
- decreased tearing (cn 7 and 8)
treatment for hzo
- topical antibiotics + steroids
- <72 hrs: valacyclovir / acyclovir, high dose prednisone
infection of the auricular perichondrium or cartilage
perichondritis due to trauma or extension of otitis externa
etiology: p aeruginosa
clinical manifestations of perichondritis
- fluctuance (fluid)
- if not treated, can form cauliflower ear (auricular chondropathy)
treatment for perichondritis
incision and drainage, placement of drain, antibiotics
inflammatory condition that involves lateral surface of tympanic membrane and medial portion of canal wall
bullous myringitis, associated with urtis
etiology: m pneumonia or viral
65% of patients with bullous myringitis have ____ hearing loss
sensorineural or mixed hearing loss, 60% will have resolution
treatment for bullous myringitis
clarithromycin, lance or puncture bullae, pain medications
acute inflammation of the middle ear with or without middle ear effusion <3-4 wks
acute otitis media
acute otitis media is most common in ___
pediatric age group (6-11 mos) due to shorter and horizontally oriented eustachian tube
common etiologies for acute otitis media
s pneumoniae
h influenzae
moraxella catarrhalis
stages of acute otitis media
hyperemia, exudation, suppuration, coalescence/surgical mastoiditis, resolution/complication
treatment for acute otitis media
<6 mos: antibiotics always
>6 mos: unilateral: observe, follow up; bilateral: antibiotics
>2 yo: unilateral observe, bilateral treat
amoxicillin, amoxicillin-clavulanate, ceftriaxone
Elicit TB history/test if not responding
complications of otitis media
MATHFLAPS
intracranial: meningitis abscess thrombophlebitis hydrocephalus
extracranial: facial nerve paralysis, labyrinthitis, subperiosteal abscess, petrositis, sensorineural hearing loss
chronic inflammation of middle ear (>12 wks) with mucopurulent discharge through perforated tympanic membrane resulting from acute/recurrent infection
chronic otitis media without cholesteatoma (ct/mri)
treatment for chronic otitis media without cholesteatoma
- topical antibiotics +/- steroids
- surgery(for hearing rehab, remove irreversibly diseased bone, mastoid and middle ear aeration)
com with keratinized mass in the middle ear or mastoid
com with cholesteatoma (smells like rotten fish)
treatment for com with cholesteatoma
- surgery!! (excision and mastoidectomy)
___ is an extension of infection from mastoid air cell tract into pneumatized anterior or posterior petrous apex
petrous apicitis (complication of otitis media)
triad of gradenigo syndrome
deep facial pain, otitis media, lateral rectus palsy or abducens nerve palsy
treatment for gradenigo syndrome
control of infection, antibiotics, surgery for failed management
