Disorders of the External and Middle Ear

Question 1

Hematoma of the External Ear:

Answer 1

Auricular Hematoma (Wrestlers Ear)
Results from direct trauma to auricle 

Shearing forces cause separation of perichondrium from underlying cartilage.
Perichondrial blood vessels are torn and ooze.
Blood collects between cartilage and loose perichondrium forming a hematoma.

if not treated, leads to cauliflower ear

Question 2

Tx of auricular hematoma:

Answer 2

incision and drainage
needle aspiration
pressure dressing, change frequently
prophylactic abx (quinolone)

Question 3

Cerumen impaction:

Answer 3

most common EAC complaint
cerumen has an acidic pH, is anti-bacterial and lubricates EAC

causes pressure and hearing loss, rarely causes pain

Question 4

Tx of cerumen impaction:

Answer 4

lavage with warm water using syringe (can use alcohol or vinegar)- DO NOT DO IF TM PERFORATION

Mineral oil helps soften wax prior to lavage

hydrogen peroxide can be irritable to older skin

Question 5

Acute Otitis Externa

Answer 5

Swimmers Ear

usually caused by bacteria; Risk factors include q-tips, flaky skin, and moisture

deep severe pain

Question 6

Tx for acute otitis externa:

Answer 6

topical abx drops

Question 7

Severe Otitis Externa:

Answer 7

pain with auricle manipulation, perichondritis is present
WILL NEED ORAL ABX (flouroquinolone)

Topical drops too, with ear wic (cipro)
beware of skin reaction to neomycin and its ototoxic effects

Question 8

Malignant Otitis Externa:

Answer 8

Mastoiditis

erosion of EAC and Mastoid
diabetics and immunosuppressed are at increased risk- mortality rate = 30%

Question 9

What is the most common bacteria of Malignant Otitis Externa:?

Answer 9

pseudomonas aeruginosa

Question 10

Dx of Malignant Otitis Externa:

Answer 10

Ct scan, bone scan

Question 11

Tx of Malignant Otitis Externa:

Answer 11

Debridement and culture directed IV abx for 6 wks or more

Question 12

Chronic Otitis Externa:

Answer 12

Recurrent episodes of AOE or severely chronic pruritic EAC
Patients find debridement enjoyable

often accompanied by dermatitis of external ear

Question 13

Tx for Chronic Otitis Externa:

Answer 13

Tx dermatitis first

vinegar and alcohol rinses, may need boric acid
Topical steroid creams or drops such as Dermotic

Question 14

External Auditory Canal Foreign Body:

Answer 14

common items: insects, beads, earing backs, cotton balls, paper, pebbles, seeds

emergency= battery

Question 15

Tx of EAC foreign body:

Answer 15

DO NOT PUSH FARTHER

gentle irrigation w/ warm water, if unsuccessful consult and OR to remove

maybe more than one foreign body! LOOK!

Question 16

Insects in the EAC:

Answer 16

apply rubbing alcohol to kill the insect

mineral oil, less painful than alcohol, works slower

Question 17

Osteoma:

Answer 17

benign bony overgrowth

Question 18

Exostoses:

Answer 18

circumferential bony swellings, chronic swimming in cold water

Question 19

Acute Otitis Media:

Answer 19

acute inflammation of the middle ear, significant ear pain!

most common disease state requiring medical tx in kids <5yo

Question 20

Risk Factors for AOM:

Answer 20

day care
tobacco exposure
race: native american
pacifier or prolonged bottle use
low socioeconomic status

Question 21

What usually supersedes a AOM?

Answer 21

viral URI or allergies, pathogenic bacteria proliferate

Question 22

PE of AOM:

Answer 22

bulging TM, immobile with signs of inflammation, must preform pneumatoscopy for accurate dx

Question 23

Tx for AOM:

Answer 23

watch and wait if >2 yo, symptoms are mild and close follow up is ensured

oral abx. (high does amoxicillin)

Surgical Tx: tympanocentesis for severe cases, myringotomy

Question 24

Mastoiditis:

Answer 24

otitis media will always cause fluid to fill mastoid
bony erosion = coalescent mastoiditis

ear protrudes forward

Question 25

Dx of Mastoiditis:

Answer 25

temporal bone CT with IV contrast

Check labs: CBC, CRP, ESR

Question 26

Tx for Mastoiditis:

Answer 26

IV abx +/- myringotomy

surgical drainage for severe cases

Question 27

Causes of TM perforation:

Answer 27

AOM w/ rupture
trauma
previous tympanostomy tubes

Question 28

Symptoms of TM perforation:

Answer 28

frequent middle ear infections
hearing loss proportional to size of perforation
drainage from ear

Question 29

Tx for TM perforation:

Answer 29

acutely: abx ear drops and keep out water
most heal spontaneously if traumatic origin

if perforations persist may need surgical repair (tympanoplasty)

Question 30

Cholesteatoma:

Answer 30

chronically draining ear

skin cells become trapped in middle ear, white cheesy material, erode surrounding structures

Question 31

Dx of cholesteatoma:

Answer 31

Temporal bone CT

Question 32

Tx of Cholesteatoma:

Answer 32

ENT referral for surgery, may need multiple b/c it can recur

Question 33

Barotrauma:

Answer 33

pressure gradient (usually negative) between middle ear space and surrounding environment

due to failure of ET to equalize pressure due to obstruction or dysfunction

Question 34

Presentation of Barotrauma:

Answer 34

acute ear pain and pressure
may develop middle ear effusion of fluid or blood
TM may rupture
Can have hearing loss and vertigo

Question 35

Tx of Barotrauma:

Answer 35

yawn, chew gum, swallow

oral decongestant, topical nasal decongestant ahead of time

may need myringotomy if severe