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ENT > Ear Infections > Flashcards

Ear Infections Flashcards

1
Q

What are symptoms of otitis externa?

A
  • Itch
  • Severe ear pain, disproportionate to size of lesion
  • Pain made worse when tragus or pinna is moved, or when otoscope is inserted
  • Tenderness on moving the jaw
  • Tender regional lymphadenitis
  • Loss of hearing
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2
Q

What are signs of otitis externa?

A
  • Ear canal is red, eczematous or swollen with shedding of the scaly skin
  • White or yellow centre filled with pus
  • Discharge
  • Inflamed eardrum
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3
Q

What are signs of chronic otitis externa?

A
  • Lack of earwax in the ear canal
  • Dry hypertrophic skin, which results in partial canal stenosis
  • Pain on manipulation of external ear canal and auricle
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4
Q

What are symptoms of chronic otitis externa?

A
  • Constant itch in the ear
  • Mild discomfort
  • Pain is mild
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5
Q

What are signs of malignant otitis externa?

A
  • Granulation tissue at bone to cartilage junction of the ear canal, exposed bone in the ear canal
  • Facial nerve palsy
  • Temperature over 39 degrees
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6
Q

What are symptoms of malignant otitis externa?

A
  • Pain and headache, more severe than clinical signs suggest
  • Vertigo
  • Profound hearing loss
  • Unremitting pain, otorrhoea, fever or malaise
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7
Q

What is the time scale of acute/chronic otitis externa?

A 
Acute = <3 weeks
Chronic = >3 weeks
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8
Q

What are causes of diffuse otitis externa?

A

Bacteria - Pseudomonas aeruginosa, Staphylococcus aureus
Fungus - Candida albicans, Aspergillus
- Seborrhoeic dermatitis (associated with dandruff, eyebrow scaling, facial redness)
- Contact dermatitis (allergic or irritant)
- Trauma

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9
Q

What are risk factors for malignant otitis externa?

A
  • Diabetes mellitus
  • Immunocompromised (HIV/AIDS, chemotherapy, CKD)
  • Radiotherapy to head and neck
  • Aural irrigation with tap water
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10
Q

What are complications of otitis externa?

A
  • Abscess
  • Chronic otitis externa
  • Fibrosis, causing stenosis and conductive deafness
  • Tympanic membrane perforation
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11
Q

What are complications of malignant otitis?

A
  • Facial nerve paralysis
  • Osteomyelitis will progressively involve the mastoid, temporal, basal skulls bones. Spreading to CSF and causing meningitis.
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12
Q

What is the management for acute otitis externa?

A
  1. Consider cleaning the external auditory ear canal
  2. Prescribe analgesia
  3. Consider topic antibiotic, with or without topical steroid for 7-14 days
  4. Oral antibiotics ONLY if cellulitis beyond ear canal, ear occluded by swelling, people who are immunocompromised
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13
Q

What is the oral antibiotic of choice for otitis externa?

A

Flucloxacillin for 7 days/ Clarithromycin if allergic

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14
Q

What are self care measures to present otitis externa?

A
  • Use ear plugs when swimming
  • Use a hair dryer to dry the ear on cool after getting it wet
  • Keep shampoo and soap out of the ear when bathing
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15
Q

What is the management for malignant otitis externa?

A

Refer urgently to ENT

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16
Q

What topical antibiotics should be prescribed?

A 
Aminoglycoside (gentamicin)
Acetic acid (earcalm) can help prevent ear infections
17
Q

What are contraindications for topical ear preparations?

A
  • Perforated tympanic membrane (ototoxic aminoglycoside)

- History of local sensitivity reaction due to recurrent use (secondary contact otitis)

18
Q

What are the causes of otitis media?

A

Viruses - RSV, rhinovirus, adenovirus, influenza, parainfluenza
Bacteria - Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, Strep pyogenes

19
Q

What are complications of otitis media?

A
  • Persistent otitis media with effusion
  • Recurrence of infection
  • Hearing loss
  • Tympanic membrane perforation
  • Labyrinthitis
  • Mastoiditis, meningitis, intracranial abscess, sinus thrombosis, facial nerve paralysis
20
Q

What will be found on otoscopic examination with otitis media?

A
  • Distinctly red, yellow or cloudy tympanic membrane
  • Bulging of the tympanic membrane, loss of normal landmarks, air-fluid level behind the TM
  • Perforation of TM and discharge in the external auditory canal
21
Q

What is the management for acute otitis media?

A

Advise -

  • Usual course of acute otitis media lasts about 3 days, but can lastup to 1 week
  • Advice regular paracetamol/ibuprofen
  • If systemically well, antibiotics are not needed as will improve within 3 days. Safety net with backup prescription.
22
Q

When are antibiotics indicated for acute otitis media?

A
  • Systemically unwell
  • Otorrhoea
  • Bilateral infection <2 years old
23
Q

What is the antibiotic for acute otitis media?

A

5-7 days of amoxicillin/clarithromycin if allergic

24
Q

What are red flags for nasopharyngeal cancer?

A
  • Persistent symptoms/signs of otitis media with effusion in between episodes
  • Persistent cervical lymphadenopathy
  • Epistaxis and nasal obstruction
25
Q

What are risk factors for otitis media?

A
  • Young and male
  • Smoking
  • Craniofacial abnormalities (cleft palate)
  • Formula feeding
  • Use of a dummy
26
Q

What is chronic suppurative otitis media?

A

A chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges through a tympanic perforation
It is a complication of AOM, after >2 weeks of discharge

27
Q

What are symptoms of CSOM?

A
  • Ear discharge >2 weeks without ear pain or fever
  • History of AOM, ear trauma, glue ear, grommet insertion
  • Hearing loss
  • Tinnitus
  • History of atopy, upper resp tractinfection
28
Q

What is the treatment for CSOM?

A
  • Do not swab the ear or initiate treatment
  • Refer for ENT assessment, likely to give antibiotics and steroids and intensive cleaning of affected ear
  • Hearing test may be done in secondary care
29
Q

What are symptoms of mastoidits?

A
  • Redness, tenderness, swelling behind the ear
  • Swelling behind the ear that causes it to stick out
  • Discharge from the ear
  • High temperature, irritability, tiredness
  • Headache
  • Hearing loss in affected ear
30
Q

Who is mastoiditis more common in?

A
  • Children who have otitis media
31
Q

What is the investigations for mastoiditis?

A
  • FBC, U+E, CRP
  • Blood cultures if pyrexic
  • Ear swab if discharge present
  • Contrast CT scan if vertigo, nystagmus, meningeal signs, headache, focal neurology
32
Q

What is the medical management for mastoiditis?

A
  • IV ceftriaxone and IV metronidazole
33
Q

What is the surgical management for mastoiditis?

A
  • If subperiosteal abscess
    1. Myringotomy/grommet
    2. Cortical mastoidectomy
34
Q

What are complications of mastoiditis?

A
  • Intracranial abscess
  • Neck abscess
  • Venous sinus thrombosis
  • CNVII palsy
  • Hearing loss permanently

ENT (8 decks)

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