Ear infections Flashcards
Otitis media is the name given to an infection in the…
Middle ear
The most common cause of bacterial otitis media is…
Haemophilus influenzae
What are the clinical features of otitis media?
- Pain
- Reduced hearing
- Vertigo
- Fever
- Ear discharge (if ruptured tympanic membrane)
In a case of otitis media, otoscopy will show…
Red, inflamed (and possibly bulging) tympanic membrane
Most cases of otitis media require antibiotics… true or false?
False:
- Most cases will resolve without antibiotics in around 3 days (but sometimes this can take up to a week)
When would you consider prescribing antibiotics in a case of otitis media?
- Systemically unwell
- Significant comorbidities
- Immunocompromised patients
You decide to prescribe antibiotics for otitis media. Which antibiotic would you prescribe first-line?
What if the patient is allergic to penicillin?
- First-line: Amoxicillin
- Penicillin allergic: Clarithromycin
Give a potential complication of otitis media
Mastoiditis
What is otitis externa?
Inflammation of the skin in the external ear canal
Otitis externa is also known as…
“Swimmer’s ear”
Aside from swimming (exposure of the ear canal to water), give another cause of otitis externa
Trauma (cotton bud misuse/earplugs)
Removal of ear wax can increase the chances of otitis externa… true or false?
True - ear wax has a protective effect against infection
Which types of pathogen are the two most common causes of otitis externa?
- Bacteria
- Fungus
Describe the clinical features of otitis externa
- Ear pain
- itchiness
- Discharge
In a case of otitis externa, otoscopy will show…
Red and inflamed ear canal
Describe the management of mild otitis externa
Acetic acid 2% (Earcalm) which has an antibacterial and antifungal effect
Describe the management of moderate otitis externa
Topical antibiotic + steroid, e.g. otomize spray
What MUST you exclude before using topical aminoglycosides? (e.g. gentamicin or neomycin)
Why is this?
You MUST exclude perforated tympanic membrane as these drugs are potentially ototoxic
If you suspect a fungal cause of otitis media, how would you treat this?
Clotrimazole ear drops
What is malignant otitis externa?
Describe the pathophysiology
A severe and potentially life-threatening form of otitis externa
Infection spreads to temporal bone, causing osteomyelitis
Malignant otitis externa is more common in which groups of patients?
- Diabetes
- HIV
- Patients taking immunosuppressant medications, e.g. chemotherapy
What are the clinical features of malignant otitis externa?
- Severe ear pain
- Headache
- Fever
In a case of malignant otitis externa, what may you observe on examination?
Granulation tissue at the junction between the bone and cartilage in the ear canal
Describe the management of malignant otitis externa
- Hospital admission under ENT
- IV antibiotics
What are the symptoms of mastoiditis?
Redness, tenderness and swelling of the mastoid process (behind the ear)
