Ear Infections Flashcards
What is otitis externa
Infection of the outer ear
Symptoms of otitis externa
Itchy, moist, dull, blocked, otorrhoea, tender pinna and tragus, discharge clumpy
Precipitating factors for otitis externa
Swimming, tropic, cotton buds, syringing.
Causes of otitis externa
Eczema, bacterial, fungal, malignant
Management of otitis externa
Ear drops, microsuction, analgesia, aural toilet, pope wick, BIPP gauze, pack ear is canal oedematous
Ear cannal problems in otitis externa
Swelling and becomes very painful and tender
Tympanic membrane in otitis externa
Difficult to visualise due to canal debris
What is otitis media
Infection of the middle ear
Bacterial causes of otitis externa
Pseudomonas Aeruginosa, Staph. Aureus, Staph. epidermidis
When does fungal otitis externa occur
Suspect if discharge resistent to Abx. Fluffy cotton wool type debris or black spots (aspergillus niger).
Symptoms of otitis media
Otalgia, fever, pain, watery discharge, pyrexia, malaise, hearing impaired
View of tympanic membrane in otitis media
Red, bulging, oedematous, perforated with mucopus pulsating through
What often preceeds otitis media
Upper RTI, often viral
Common causes of otitis media
step pneumoniae, H influenza B, M catarrhalis
What age does otitis media usually occur
2 - 5 years of age
Management of otitis media
Abx or conservative management. Nasal decongestants.
What to do if the tympanic membrane perforates
Keep dry and review in 6-8 weeks, often heal
Complications of otitis media
Mastoiditis, petrositis, labyrinthitis, facial paralysis, subdural abscesses, extradural abscesses, lateral sinus thromboplebitis, meningitis, brain abscesses
Red flags of otitis media
drowsiness, meningism, severe headache, vomiting, retroorbital pain, squnit or diplopia, vision problems, limb weakness, gait or coordination issues, pain beyond ear, extensive headache or facial pain.
What is glue ear
Inflammation of middle ear mucosa with middle ear effusion for 3 months without infection.
When are the peak ages for glue ear
ages 2 and 5 years
Association with glue ear
Cleft palate, Downs, cilairy dyskinesia, craniofacial syndromes, winter>summer
Management of glue ear
Watchful waiting for 3 months, hearing aids, grommets. Hearing needs to be better in ear by 25-30dB
What is mastoiditis
Infection of the mastoid air cells behind the ear, medical emergency
Symptoms of mastoiditis
Subperiosteal abscess, pain around the ear, red, protrusion of pinna, bulging canal wall, unwell
Treatment of mastoiditis
IV Abx, IV fluids, CT with mastoid surgery, requiring surgical drainage and mastoidectomy.
How does mastoiditis occur
Complication of otitis media
Complications of mastoiditis
Can spread to inner ear or intracranial space
What is labyrinthitis
Inflammation of the bony labyrinth of the inner ear including the semicicular canals, vestibule and cochlea.
Symptoms of labyrinthitis
Acute onset vertigo, hearing loss nad tinnitus. Associated symptoms with causative virus
Diagnosis of labyrinthitis
Clinical diagnosis based on history and examination findings. Exclude central casues of vertigo. Head impulse test
Management of labyrinthitis
Supportive care and short term use of medication to suppress symptoms such as prochlorperazine and antihistamines.
Abx for bacterial causes
Cause of labyrinthitis
Viral upper RTI. Can be caused by bacterial infection. Usually secondary to otitis media or meningitis
Symptoms of necrotising external otitis
Progressive pain and drainage from the EAC. Granulation tissue often present. Some facial nerve palsy
What is necrotising external otitis
Malignant external otitis from pseudomonas infection of soft tissue, cartilage and bone
Treatment of necrotising external otitis
Radical surgical debridement with combination semi-synthetic penicillin and aminoglycoside for 4-6 weeks.
Symptoms of perichondritis
Pain and warmth to the pinna following trauma or infection, erythema, induration.
Treatment of perichondritis
Betadine or boric acid wet to dry dressings to open wound.
What is the most common organism for perichondritis
pseudomonas aeruginosa
What is a complication of perichondritis and how to resolve it
Chondritis with abscess, then incision, drainage and debridement of non-viable cartilage
Symptoms of otomycosis
Itching or mild otalgia, secondary bacterial infection may produce intense pain
Signs of otomycosis if from apergilla nigrans
Grayish membrane with hyphae visible under microscope. Erythema of underlying epithelium
Treatment of otomycosis
Clean external ear canal, topical cresyl acetate or 1% gentian violet and/or boric or aceteic acid and alcohol drops
Symptoms of bullous myringitis
Otalgia, haemorrhagic blebs on TM and adjacent canal.
Treatment of bullous myringitis
Incision of blebs if severe pain, prophylactic oral abx to prevent otitis media, anesthetic otic drops
