CBM -Ear Infections

Question 1

Ear Infections

The Ear?

Answer 1

• Hearing starts with the outer ear.
• When a sound is made outside the outer ear, the sound waves, or vibrations, travel down the external auditory canal and strike the eardrum (tympanic membrane).
• The eardrum vibrates.
• The vibrations are then passed to three tiny bones in the middle ear called the ossicles.

Question 2

Ear Infections

Inner Ear?

Answer 2

• The inner ear is called a labyrinth. The labyrinth itself is comprised of a bone shell known as the bony labyrinth, which is designed to offer protection for the membranous labyrinth it encompasses. There is a space in between theses two labyrinths which is filled with fluid known as perilymph.
• Perilymph is a secreted fluid, constantly supplied by the cells which line the bony canal. A second fluid can be found within the structure of the tubular maze inside the membranous labyrinth. This fluid is known as endolymph. Both fluids are equipped to help discern vibrations to assist in the process of hearing as well as help the body maintain a sense of balance and equilibrium.
• There are three structural cavities within the bony labyrinth, the vestibule, the semicircular canals, and the cochlea. The necessary organs for hearing and maintaining balance are embedded and supported within these three regions.

Question 3

Ear Infections

Symptoms?

Answer 3

EAR INFECTION SYMPTOMS

• Symptoms of an ear infection can include fevers, ear pain, stuffiness of the head, pressure behind the eye, and ear drainage.
• Small children who can not communicate that their ears are bothering them will likely tug on their ear or continuously put their fingers or other objects in their ear in an attempt to rid themselves of discomfort.
• Ear infection pain can range from mild to severe.

Question 4

Ear Infections

Types of Ear Infection?

Answer 4

• otitis externa
• otitis media – acute or chronic
• serous otitis media
• infectious myringitis
• acute mastoiditis
• vestibular neuronitis
• herpes zoster of the ear

Question 5

Ear Infection

Otitis Externa?

Answer 5

• Otitis externa is a diffuse inflammation of the skin lining the external auditory meatus

Management:

• Send a swab to the lab
• PX suitable eardrops – containing anti-inflammatory/antibiotic (Gentamicin/hydrocortisone)
• oral antibiotics may be prescribed with topical treatment. Use flucloxacillin (if not penicillin allergic) unless pseudomonas is suspected when ciprofloxacin (or aminoglycoside) should be used

Question 6

Ear Infection

Otitis Media

Clinical Features?

Answer 6

• Acute otitis media is an acute inflammation of the middle ear cavity.
• It is a common condition, occurring most frequently in children, and is often bilateral.
• Acute otitis media has a peak incidence of between 3 years and six years

Clinical features associated with an increase in the likelihood of acute otitis media:

• ear pain, ear rubbing, cloudy eardrum, bulging eardrum
• distinctly immobile eardrum, distinctly red eardrum
• 80% recover in around three days without antibiotics
• complications are rare
• a review concluded that antibiotics should not be prescribed routinely for acute otitis media in children

Question 7

Ear Infection

Otitis Media

Management?

Answer 7

• Symptom Resolution/reduction of recurrence
• it is not considered cured until both the appearance of tympanic membrane, and hearing, are normal.
• most children have spontaneous resolution within seven to 14 days
• antibiotics should not routinely be prescribed initially for all children
• delaying antibiotic therapy in selected patients reduces costs and side effects and minimizes emergence of resistant strains.

Question 8

Ear Infection

SEROUS OTITIS MEDIA?

Answer 8

• Is a specific type of otitis media with effusion caused by transudate formation as a result of a rapid decrease in middle ear pressure relative to the atmospheric pressure.
• The fluid in this case is watery and clear.
• Secretory otitis media’, ‘otitis media with effusion (OME)’, or `glue ear’, is the accumulation of serous or mucoid fluid (but not mucopurulent fluid) in the middle ear cavity without signs and symptoms of an acute infection

Question 9

Ear Infection

INFECTIOUS MYRINGITIS?

Answer 9

• Myringitis bullosa occurs when there are painful vesicles on the tympanic membrane.
• This condition is associated with mycoplasma or viral respiratory infections.

Question 10

Ear Infection

HERPES ZOSTER OF THE EAR?

Answer 10

• Shingles is an acute, unilateral, self-limiting inflammatory disease of cerebral ganglia and the ganglia of posterior nerve roots and peripheral nerves in a segmented distribution
• Caused by Varicella Zoster virus (VZV) - the chicken pox virus

Question 11

Ear Infection

Acute Mastoiditis?

Answer 11

• Acute mastoiditis is the result of extension of acute otitis media into the mastoid air cells with an accompanying suppuration and bone necrosis, which may result in extradural and subperiosteal abscesses.
• Acute mastoiditis was common in the pre-antibiotic era. However it is now rarely seen in the developed world.

Question 12

Ear Infection

Vestibular Neuronitis?

Answer 12

• Disorder that affects the nerve of the inner ear called the vestibulocochlear nerve.
• The disorder may cause a person to experience such symptoms as sudden, severe vertigo (spinning/swaying sensation), dizziness, balance difficulties, nausea, vomiting, and concentration difficulties.