Ear Infections Flashcards
What are symptoms of otitis externa?
- 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
What are signs of otitis externa?
- Ear canal is red, eczematous or swollen with shedding of the scaly skin
- White or yellow centre filled with pus
- Discharge
- Inflamed eardrum
What are signs of chronic otitis externa?
- 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
What are symptoms of chronic otitis externa?
- Constant itch in the ear
- Mild discomfort
- Pain is mild
What are signs of malignant otitis externa?
- Granulation tissue at bone to cartilage junction of the ear canal, exposed bone in the ear canal
- Facial nerve palsy
- Temperature over 39 degrees
What are symptoms of malignant otitis externa?
- Pain and headache, more severe than clinical signs suggest
- Vertigo
- Profound hearing loss
- Unremitting pain, otorrhoea, fever or malaise
What is the time scale of acute/chronic otitis externa?
Acute = <3 weeks Chronic = >3 weeks
What are causes of diffuse otitis externa?
Bacteria - Pseudomonas aeruginosa, Staphylococcus aureus
Fungus - Candida albicans, Aspergillus
- Seborrhoeic dermatitis (associated with dandruff, eyebrow scaling, facial redness)
- Contact dermatitis (allergic or irritant)
- Trauma
What are risk factors for malignant otitis externa?
- Diabetes mellitus
- Immunocompromised (HIV/AIDS, chemotherapy, CKD)
- Radiotherapy to head and neck
- Aural irrigation with tap water
What are complications of otitis externa?
- Abscess
- Chronic otitis externa
- Fibrosis, causing stenosis and conductive deafness
- Tympanic membrane perforation
What are complications of malignant otitis?
- Facial nerve paralysis
- Osteomyelitis will progressively involve the mastoid, temporal, basal skulls bones. Spreading to CSF and causing meningitis.
What is the management for acute otitis externa?
- Consider cleaning the external auditory ear canal
- Prescribe analgesia
- Consider topic antibiotic, with or without topical steroid for 7-14 days
- Oral antibiotics ONLY if cellulitis beyond ear canal, ear occluded by swelling, people who are immunocompromised
What is the oral antibiotic of choice for otitis externa?
Flucloxacillin for 7 days/ Clarithromycin if allergic
What are self care measures to present otitis externa?
- 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
What is the management for malignant otitis externa?
Refer urgently to ENT
What topical antibiotics should be prescribed?
Aminoglycoside (gentamicin) Acetic acid (earcalm) can help prevent ear infections
What are contraindications for topical ear preparations?
- Perforated tympanic membrane (ototoxic aminoglycoside)
- History of local sensitivity reaction due to recurrent use (secondary contact otitis)
What are the causes of otitis media?
Viruses - RSV, rhinovirus, adenovirus, influenza, parainfluenza
Bacteria - Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, Strep pyogenes
What are complications of otitis media?
- Persistent otitis media with effusion
- Recurrence of infection
- Hearing loss
- Tympanic membrane perforation
- Labyrinthitis
- Mastoiditis, meningitis, intracranial abscess, sinus thrombosis, facial nerve paralysis
What will be found on otoscopic examination with otitis media?
- 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
What is the management for acute otitis media?
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.
When are antibiotics indicated for acute otitis media?
- Systemically unwell
- Otorrhoea
- Bilateral infection <2 years old
What is the antibiotic for acute otitis media?
5-7 days of amoxicillin/clarithromycin if allergic
What are red flags for nasopharyngeal cancer?
- Persistent symptoms/signs of otitis media with effusion in between episodes
- Persistent cervical lymphadenopathy
- Epistaxis and nasal obstruction
What are risk factors for otitis media?
- Young and male
- Smoking
- Craniofacial abnormalities (cleft palate)
- Formula feeding
- Use of a dummy
What is chronic suppurative otitis media?
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
What are symptoms of CSOM?
- 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
What is the treatment for CSOM?
- 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
What are symptoms of mastoidits?
- 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
Who is mastoiditis more common in?
- Children who have otitis media
What is the investigations for mastoiditis?
- FBC, U+E, CRP
- Blood cultures if pyrexic
- Ear swab if discharge present
- Contrast CT scan if vertigo, nystagmus, meningeal signs, headache, focal neurology
What is the medical management for mastoiditis?
- IV ceftriaxone and IV metronidazole
What is the surgical management for mastoiditis?
- If subperiosteal abscess
1. Myringotomy/grommet
2. Cortical mastoidectomy
What are complications of mastoiditis?
- Intracranial abscess
- Neck abscess
- Venous sinus thrombosis
- CNVII palsy
- Hearing loss permanently
