Blake: Acute Otitis Externa Flashcards
The acute form of otitis externa is caused primarily by (blank) infection with the following organisms…
bacterial infection with Pseudomonas aeruginosa and S. aureus
How does acute otitis externa present?
rapid onset of ear canal inflammation, leading to itching, edema, canal erythema, otorrhea, tenderness w movement of the tragus or pinna
When does acute otitis externa often occur?
after swimming or minor trauma from inappropriate cleaning
What is the treatment of choice for acute otitis externa in uncomplicated conditions?
acetic acid
aminoglycosides
polymyxin B
quinolones
**come in preparation with or without corticosteroids
In treating AOE, the addition of (blank) may help symptoms resolve for quickly
corticosteroids
When are neomycin/polymyxin B/hydrocortisone preparations used? When are oral antibiotics used?
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
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?
malignant otitis externa
**occurs primarily in older patients and patients with diabetes mellitus
If otitis externa lasts (blank) or longer, it is considered chronic. What causes chronic otitis externa?
> 3months; allergies, chronic dermatologic conditions, inadequately treated acute otitis externa
What are some predisposing factors for AOE?
swimming (esp in fresh water) eczema and seborrhea trauma from earwax removal hearing aids wax buildup
Has the effectiveness of acetic acid application been proven?
no; no trials have examined its effectiveness
How is AOE diagnosed clinically?
based on signs/symptoms of canal inflammation
What are some things you should ask about when a patient comes in with AOE?
history of presenting and associated symptoms water exposure local trauma/earwax removal diabetes ear surgeries
Itching is often predominant symptom, erythematous canal, lasts more than 3 months
chronic otitis media
Chronic otorrhea (drainage), nonintact tympanic membrane
chronic suppurative otitis media
Allergic reaction to materials in contact with the skin; itching is a predominant symptom
contact dermatitis
Itching is the predominant symptom; often chronic, history of atopy (allergy), outbreaks in other locations
eczema
High fever, granulation tissue or necrotic tissue in ear canal, may have cranial nerve involvement; immunocompromised pts or those w diabetes mellitus
malignant otitis media
Itching is a predominant symptom, thick material in canal, less edema; may see fungal elements on otoscopy
otomycosis
This is the mainstay of treatment for AOE
topical antimicrobials w or w/o topical corticosteroids
Eye drops can be used for ear infections
True
T/F: In regards to aminoglycosides, polymyxin B, quinolones, and acetic acid, there is one clear agent that is the most effective.
False; no consistent evidence has shown that one agent is superior to the next
Should systemic antibiotics be used with AOE?
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
First line therapy if tympanic membrane is intact?
neomycin/polymyxinB/hydrocortisone otic preparation
**effective, low cost
First line therapy if the tympanic membrane not intact?
Ciprodex (Ofloxacin and ciprofloxacin/dexamethasone)
How should you administer the antimicrobial solution to a patient w AOE?
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
This is a common and potentially debilitating symptom of AOE
pain
What can be used to treat the pain?
NSAIDs, acetaminophen
What are some appropriate ways to remove a block of earwax?
gentle lavage suctioning
dry mopping under microscope
**make sure the tympanic membrane is intact
How would you treat chronic otitis externa?
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