Blake: Acute Otitis Externa

Question 1

The acute form of otitis externa is caused primarily by (blank) infection with the following organisms…

Answer 1

bacterial infection with Pseudomonas aeruginosa and S. aureus

Question 2

How does acute otitis externa present?

Answer 2

rapid onset of ear canal inflammation, leading to itching, edema, canal erythema, otorrhea, tenderness w movement of the tragus or pinna

Question 3

When does acute otitis externa often occur?

Answer 3

after swimming or minor trauma from inappropriate cleaning

Question 4

What is the treatment of choice for acute otitis externa in uncomplicated conditions?

Answer 4

acetic acid
aminoglycosides
polymyxin B
quinolones

**come in preparation with or without corticosteroids

Question 5

In treating AOE, the addition of (blank) may help symptoms resolve for quickly

Answer 5

corticosteroids

Question 6

When are neomycin/polymyxin B/hydrocortisone preparations used? When are oral antibiotics used?

Answer 6

when the tympanic membrane is intact; oral antibiotics are reserved for cases in which the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection

Question 7

On rare occasions, AOE may invade the surrounding soft tissue and bone. What is this called? What type of patients is this more common in?

Answer 7

malignant otitis externa

**occurs primarily in older patients and patients with diabetes mellitus

Question 8

If otitis externa lasts (blank) or longer, it is considered chronic. What causes chronic otitis externa?

Answer 8

> 3months; allergies, chronic dermatologic conditions, inadequately treated acute otitis externa

Question 9

What are some predisposing factors for AOE?

Answer 9

swimming (esp in fresh water)
eczema and seborrhea
trauma from earwax removal
hearing aids
wax buildup

Question 10

Has the effectiveness of acetic acid application been proven?

Answer 10

no; no trials have examined its effectiveness

Question 11

How is AOE diagnosed clinically?

Answer 11

based on signs/symptoms of canal inflammation

Question 12

What are some things you should ask about when a patient comes in with AOE?

Answer 12

history of presenting and associated symptoms
water exposure
local trauma/earwax removal
diabetes
ear surgeries

Question 13

Itching is often predominant symptom, erythematous canal, lasts more than 3 months

Answer 13

chronic otitis media

Question 14

Chronic otorrhea (drainage), nonintact tympanic membrane

Answer 14

chronic suppurative otitis media

Question 15

Allergic reaction to materials in contact with the skin; itching is a predominant symptom

Answer 15

contact dermatitis

Question 16

Itching is the predominant symptom; often chronic, history of atopy (allergy), outbreaks in other locations

Answer 16

eczema

Question 17

High fever, granulation tissue or necrotic tissue in ear canal, may have cranial nerve involvement; immunocompromised pts or those w diabetes mellitus

Answer 17

malignant otitis media

Question 18

Itching is a predominant symptom, thick material in canal, less edema; may see fungal elements on otoscopy

Answer 18

otomycosis

Question 19

This is the mainstay of treatment for AOE

Answer 19

topical antimicrobials w or w/o topical corticosteroids

Question 20

Eye drops can be used for ear infections

Answer 20

True

Question 21

T/F: In regards to aminoglycosides, polymyxin B, quinolones, and acetic acid, there is one clear agent that is the most effective.

Answer 21

False; no consistent evidence has shown that one agent is superior to the next

Question 22

Should systemic antibiotics be used with AOE?

Answer 22

nooo, they should only be used when the infection has spread beyond the ear canal, or when there is uncontrolled diabetes, immunocompromised pt, or an inability otherwise to use topicals

Question 23

First line therapy if tympanic membrane is intact?

Answer 23

neomycin/polymyxinB/hydrocortisone otic preparation

**effective, low cost

Question 24

First line therapy if the tympanic membrane not intact?

Answer 24

Ciprodex (Ofloxacin and ciprofloxacin/dexamethasone)

Question 25

How should you administer the antimicrobial solution to a patient w AOE?

Answer 25

Have the pt lay on his/her side, fill ear canal with drops until it is full and have the pt remain in this position for 3-5mins; may be best to have someone else administer

**pt should minimize trauma to the ear, avoid water exposure, etc

Question 26

This is a common and potentially debilitating symptom of AOE

Answer 26

pain

Question 27

What can be used to treat the pain?

Answer 27

NSAIDs, acetaminophen

Question 28

What are some appropriate ways to remove a block of earwax?

Answer 28

gentle lavage suctioning
dry mopping under microscope

**make sure the tympanic membrane is intact

Question 29

How would you treat chronic otitis externa?

Answer 29

depends on the underlying cause; many cases are due to allergy so you would want to remove the offending agent and use topical or systemic corticosteroids to reduce inflammation