Ear infections

Question 1

Otitis media is the name given to an infection in the…

Answer 1

Middle ear

Question 2

The most common cause of bacterial otitis media is…

Answer 2

Haemophilus influenzae

Question 3

What are the clinical features of otitis media?

Answer 3

• Pain
• Reduced hearing
• Vertigo
• Fever
• Ear discharge (if ruptured tympanic membrane)

Question 4

In a case of otitis media, otoscopy will show…

Answer 4

Red, inflamed (and possibly bulging) tympanic membrane

Question 5

Most cases of otitis media require antibiotics… true or false?

Answer 5

False:

- Most cases will resolve without antibiotics in around 3 days (but sometimes this can take up to a week)

Question 6

When would you consider prescribing antibiotics in a case of otitis media?

Answer 6

• Systemically unwell
• Significant comorbidities
• Immunocompromised patients

Question 7

You decide to prescribe antibiotics for otitis media. Which antibiotic would you prescribe first-line?

What if the patient is allergic to penicillin?

Answer 7

• First-line: Amoxicillin

- Penicillin allergic: Clarithromycin

Question 8

Give a potential complication of otitis media

Answer 8

Mastoiditis

Question 9

What is otitis externa?

Answer 9

Inflammation of the skin in the external ear canal

Question 10

Otitis externa is also known as…

Answer 10

“Swimmer’s ear”

Question 11

Aside from swimming (exposure of the ear canal to water), give another cause of otitis externa

Answer 11

Trauma (cotton bud misuse/earplugs)

Question 12

Removal of ear wax can increase the chances of otitis externa… true or false?

Answer 12

True - ear wax has a protective effect against infection

Question 13

Which types of pathogen are the two most common causes of otitis externa?

Answer 13

• Bacteria

- Fungus

Question 14

Describe the clinical features of otitis externa

Answer 14

• Ear pain
• itchiness
• Discharge

Question 15

In a case of otitis externa, otoscopy will show…

Answer 15

Red and inflamed ear canal

Question 16

Describe the management of mild otitis externa

Answer 16

Acetic acid 2% (Earcalm) which has an antibacterial and antifungal effect

Question 17

Describe the management of moderate otitis externa

Answer 17

Topical antibiotic + steroid, e.g. otomize spray

Question 18

What MUST you exclude before using topical aminoglycosides? (e.g. gentamicin or neomycin)

Why is this?

Answer 18

You MUST exclude perforated tympanic membrane as these drugs are potentially ototoxic

Question 19

If you suspect a fungal cause of otitis media, how would you treat this?

Answer 19

Clotrimazole ear drops

Question 20

What is malignant otitis externa?

Describe the pathophysiology

Answer 20

A severe and potentially life-threatening form of otitis externa

Infection spreads to temporal bone, causing osteomyelitis

Question 21

Malignant otitis externa is more common in which groups of patients?

Answer 21

• Diabetes
• HIV
• Patients taking immunosuppressant medications, e.g. chemotherapy

Question 22

What are the clinical features of malignant otitis externa?

Answer 22

• Severe ear pain
• Headache
• Fever

Question 23

In a case of malignant otitis externa, what may you observe on examination?

Answer 23

Granulation tissue at the junction between the bone and cartilage in the ear canal

Question 24

Describe the management of malignant otitis externa

Answer 24

• Hospital admission under ENT

- IV antibiotics

Question 25

What are the symptoms of mastoiditis?

Answer 25

Redness, tenderness and swelling of the mastoid process (behind the ear)