Ear Infections

Question 1

What is otitis externa

Answer 1

Infection of the outer ear

Question 2

Symptoms of otitis externa

Answer 2

Itchy, moist, dull, blocked, otorrhoea, tender pinna and tragus, discharge clumpy

Question 3

Precipitating factors for otitis externa

Answer 3

Swimming, tropic, cotton buds, syringing.

Question 4

Causes of otitis externa

Answer 4

Eczema, bacterial, fungal, malignant

Question 5

Management of otitis externa

Answer 5

Ear drops, microsuction, analgesia, aural toilet, pope wick, BIPP gauze, pack ear is canal oedematous

Question 6

Ear cannal problems in otitis externa

Answer 6

Swelling and becomes very painful and tender

Question 7

Tympanic membrane in otitis externa

Answer 7

Difficult to visualise due to canal debris

Question 8

What is otitis media

Answer 8

Infection of the middle ear

Question 9

Bacterial causes of otitis externa

Answer 9

Pseudomonas Aeruginosa, Staph. Aureus, Staph. epidermidis

Question 10

When does fungal otitis externa occur

Answer 10

Suspect if discharge resistent to Abx. Fluffy cotton wool type debris or black spots (aspergillus niger).

Question 11

Symptoms of otitis media

Answer 11

Otalgia, fever, pain, watery discharge, pyrexia, malaise, hearing impaired

Question 12

View of tympanic membrane in otitis media

Answer 12

Red, bulging, oedematous, perforated with mucopus pulsating through

Question 13

What often preceeds otitis media

Answer 13

Upper RTI, often viral

Question 14

Common causes of otitis media

Answer 14

step pneumoniae, H influenza B, M catarrhalis

Question 15

What age does otitis media usually occur

Answer 15

2 - 5 years of age

Question 16

Management of otitis media

Answer 16

Abx or conservative management. Nasal decongestants.

Question 17

What to do if the tympanic membrane perforates

Answer 17

Keep dry and review in 6-8 weeks, often heal

Question 18

Complications of otitis media

Answer 18

Mastoiditis, petrositis, labyrinthitis, facial paralysis, subdural abscesses, extradural abscesses, lateral sinus thromboplebitis, meningitis, brain abscesses

Question 19

Red flags of otitis media

Answer 19

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.

Question 20

What is glue ear

Answer 20

Inflammation of middle ear mucosa with middle ear effusion for 3 months without infection.

Question 21

When are the peak ages for glue ear

Answer 21

ages 2 and 5 years

Question 22

Association with glue ear

Answer 22

Cleft palate, Downs, cilairy dyskinesia, craniofacial syndromes, winter>summer

Question 23

Management of glue ear

Answer 23

Watchful waiting for 3 months, hearing aids, grommets. Hearing needs to be better in ear by 25-30dB

Question 24

What is mastoiditis

Answer 24

Infection of the mastoid air cells behind the ear, medical emergency

Question 25

Symptoms of mastoiditis

Answer 25

Subperiosteal abscess, pain around the ear, red, protrusion of pinna, bulging canal wall, unwell

Question 26

Treatment of mastoiditis

Answer 26

IV Abx, IV fluids, CT with mastoid surgery, requiring surgical drainage and mastoidectomy.

Question 27

How does mastoiditis occur

Answer 27

Complication of otitis media

Question 28

Complications of mastoiditis

Answer 28

Can spread to inner ear or intracranial space

Question 29

What is labyrinthitis

Answer 29

Inflammation of the bony labyrinth of the inner ear including the semicicular canals, vestibule and cochlea.

Question 30

Symptoms of labyrinthitis

Answer 30

Acute onset vertigo, hearing loss nad tinnitus. Associated symptoms with causative virus

Question 31

Diagnosis of labyrinthitis

Answer 31

Clinical diagnosis based on history and examination findings. Exclude central casues of vertigo. Head impulse test

Question 32

Management of labyrinthitis

Answer 32

Supportive care and short term use of medication to suppress symptoms such as prochlorperazine and antihistamines. Abx for bacterial causes

Question 33

Cause of labyrinthitis

Answer 33

Viral upper RTI. Can be caused by bacterial infection. Usually secondary to otitis media or meningitis

Question 34

Symptoms of necrotising external otitis

Answer 34

Progressive pain and drainage from the EAC. Granulation tissue often present. Some facial nerve palsy

Question 35

What is necrotising external otitis

Answer 35

Malignant external otitis from pseudomonas infection of soft tissue, cartilage and bone

Question 36

Treatment of necrotising external otitis

Answer 36

Radical surgical debridement with combination semi-synthetic penicillin and aminoglycoside for 4-6 weeks.

Question 37

Symptoms of perichondritis

Answer 37

Pain and warmth to the pinna following trauma or infection, erythema, induration.

Question 38

Treatment of perichondritis

Answer 38

Betadine or boric acid wet to dry dressings to open wound.

Question 39

What is the most common organism for perichondritis

Answer 39

pseudomonas aeruginosa

Question 40

What is a complication of perichondritis and how to resolve it

Answer 40

Chondritis with abscess, then incision, drainage and debridement of non-viable cartilage

Question 41

Symptoms of otomycosis

Answer 41

Itching or mild otalgia, secondary bacterial infection may produce intense pain

Question 42

Signs of otomycosis if from apergilla nigrans

Answer 42

Grayish membrane with hyphae visible under microscope. Erythema of underlying epithelium

Question 43

Treatment of otomycosis

Answer 43

Clean external ear canal, topical cresyl acetate or 1% gentian violet and/or boric or aceteic acid and alcohol drops

Question 44

Symptoms of bullous myringitis

Answer 44

Otalgia, haemorrhagic blebs on TM and adjacent canal.

Question 45

Treatment of bullous myringitis

Answer 45

Incision of blebs if severe pain, prophylactic oral abx to prevent otitis media, anesthetic otic drops