Disorders of the External and Middle Ear Flashcards
Hematoma of the External Ear:
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
Tx of auricular hematoma:
incision and drainage
needle aspiration
pressure dressing, change frequently
prophylactic abx (quinolone)
Cerumen impaction:
most common EAC complaint
cerumen has an acidic pH, is anti-bacterial and lubricates EAC
causes pressure and hearing loss, rarely causes pain
Tx of cerumen impaction:
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
Acute Otitis Externa
Swimmers Ear
usually caused by bacteria; Risk factors include q-tips, flaky skin, and moisture
deep severe pain
Tx for acute otitis externa:
topical abx drops
Severe Otitis Externa:
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
Malignant Otitis Externa:
Mastoiditis
erosion of EAC and Mastoid
diabetics and immunosuppressed are at increased risk- mortality rate = 30%
What is the most common bacteria of Malignant Otitis Externa:?
pseudomonas aeruginosa
Dx of Malignant Otitis Externa:
Ct scan, bone scan
Tx of Malignant Otitis Externa:
Debridement and culture directed IV abx for 6 wks or more
Chronic Otitis Externa:
Recurrent episodes of AOE or severely chronic pruritic EAC
Patients find debridement enjoyable
often accompanied by dermatitis of external ear
Tx for Chronic Otitis Externa:
Tx dermatitis first
vinegar and alcohol rinses, may need boric acid
Topical steroid creams or drops such as Dermotic
External Auditory Canal Foreign Body:
common items: insects, beads, earing backs, cotton balls, paper, pebbles, seeds
emergency= battery
Tx of EAC foreign body:
DO NOT PUSH FARTHER
gentle irrigation w/ warm water, if unsuccessful consult and OR to remove
maybe more than one foreign body! LOOK!
Insects in the EAC:
apply rubbing alcohol to kill the insect
mineral oil, less painful than alcohol, works slower
Osteoma:
benign bony overgrowth
Exostoses:
circumferential bony swellings, chronic swimming in cold water
Acute Otitis Media:
acute inflammation of the middle ear, significant ear pain!
most common disease state requiring medical tx in kids <5yo
Risk Factors for AOM:
day care tobacco exposure race: native american pacifier or prolonged bottle use low socioeconomic status
What usually supersedes a AOM?
viral URI or allergies, pathogenic bacteria proliferate
PE of AOM:
bulging TM, immobile with signs of inflammation, must preform pneumatoscopy for accurate dx
Tx for AOM:
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
Mastoiditis:
otitis media will always cause fluid to fill mastoid
bony erosion = coalescent mastoiditis
ear protrudes forward
Dx of Mastoiditis:
temporal bone CT with IV contrast
Check labs: CBC, CRP, ESR
Tx for Mastoiditis:
IV abx +/- myringotomy
surgical drainage for severe cases
Causes of TM perforation:
AOM w/ rupture
trauma
previous tympanostomy tubes
Symptoms of TM perforation:
frequent middle ear infections
hearing loss proportional to size of perforation
drainage from ear
Tx for TM perforation:
acutely: abx ear drops and keep out water
most heal spontaneously if traumatic origin
if perforations persist may need surgical repair (tympanoplasty)
Cholesteatoma:
chronically draining ear
skin cells become trapped in middle ear, white cheesy material, erode surrounding structures
Dx of cholesteatoma:
Temporal bone CT
Tx of Cholesteatoma:
ENT referral for surgery, may need multiple b/c it can recur
Barotrauma:
pressure gradient (usually negative) between middle ear space and surrounding environment
due to failure of ET to equalize pressure due to obstruction or dysfunction
Presentation of Barotrauma:
acute ear pain and pressure
may develop middle ear effusion of fluid or blood
TM may rupture
Can have hearing loss and vertigo
Tx of Barotrauma:
yawn, chew gum, swallow
oral decongestant, topical nasal decongestant ahead of time
may need myringotomy if severe
