Ear

Question 1

Answer 1

Otitis externa

Disruption to earwax layer –> infection.
Wet: swimming, humid. Prolonged earbud use.

Fungal
Pseudomonas

Invasive temporal bone OM in immunocompromised.

Mx:
- Check TM isn’t perforated before putting anything into ear.
- Aural toilet (dry, irrigate, suction)
- Otocomb 3 drops TDS via ear wick
- Keep dry

Question 2

Ear wick insertion

Answer 2

Insert
Drops to expand
Continue usual regimen via wick
Change 2-3 daily

Question 3

Answer 3

Perichondritis.

Pseudomonas, S auerus

Can be difficult to distinguish from auricular cellulitis. Best to assume

• Remove earrings
• Mild: PO CIPRO 750mg, BD for 10 days
• Mod/Sev: IV TAZOCIN

Question 4

Otitis media: risk factors

Answer 4

Smoke
Formula fed
Unvaccinated
Antibiotic overuse

Question 5

Otitis media: organisms

Answer 5

OM is primarily bacterial

Hib, Strep pneum, morexella (most common)

Question 6

Otitis media: complications

Answer 6

Mastoiditis
Facial nerve paralysis
Tympanic perforation
CNS infection (meningitis, abscess)
Central venous sinus thrombosis

Persistent effusion (>3mo)

Question 7

Otitis media: Management

Answer 7

• Assess for Cx (mastoiditis, facial nerve, CNS)
• Despite being (usually) bacterial, OM is mostly self-limiting in 3-4 days.
• Routine antis if:
  –> <6mo
  –> Unwell/ immunocomp
  –> Complications
  –> ATSI
  –> Only good ear/ Cochlear
• If PERFORATION present, give Ciprofloxacin drops direct.
  –> Only time we use drops with open drum.
• Others: watch and wait , +/- script if no improvement in 2-3 days.
• GP at 2/52 to check ?ongoing effusion

Use High dose AMOXICILLIN
–> 30mg/kg BD for 5 days
–> If fails, Augmentin

Question 8

Mastoiditis:

Answer 8

Infection of mastoid air cells.
–> CNS spread
–> Osteomyelitis

CLINICAL diagnosis.
- Acute OM
- Protruding auricle
- Postauricular swelling/ erythema
Fluid in mastoid on imaging is non-specific in isolation.

Only CT if evidence/concerns about CNS extension.

• IV FLUCLOX + CEFTRIAXONE
• ENT (+- mastoidectomy)

Question 9

2 complications of CHRONIC/RECURRENT OM:

Answer 9

“Glue ear” (persistent middle ear effusion)

Cholesteatoma

Question 10

Tympanic perforation: management

Answer 10

<50% perf
- Drops only if contaminated ciprofloxacin
- No swimming
- No valsalva
- Should heal in 4-6 weeks

>50% perf
- Drops
- ENT

Question 11

Ear drops:

Answer 11

SOFRADEX
- Anti
- Steroid

OTOCOMB
- Anti
- Antifungal
- Steroid

CIPROFLOXACIN
–> Only ones safe with tympanic perforation (not ototoxic)

Question 12

Answer 12

Cholesteatoma (confusing name)

Abnormal growth comprised on keratinised skin cells.

Can invade/destroy middle/inner ear:
–> Vertigo
–> Hearing loss
–> Intracranial invasion