ear infections Flashcards
what is otitis externa
Inflammation of external ear canal, in some cases can involve oedema
aka swimmers ear
otitis externa can be triggered by bacterial infection caused by (2)
P. aeruginosa or S. aureus
Important to consider underlying otitis media as otitis externa may be secondary to…
otorrhoea from otitis media
are abx needed for otitis externa
- Oral abx rarely indicated, but if required, consider seeking specialist advice
what product can you give for otitis externa
- Solution of acetic acid 2% act as an astringent in the external ear canal by reducing pH and reducing bacterial and fungal cell growth
- May be used to treat mild otitis externa and is comparable to anti infective combined with a CC
- Efficacy is reduced if treatment extends beyond one week
If a mild to moderate, uncomplicated fungal infection suspected in the context of chronic otitis externa, what can you give
topical antifungal such as clotrimazole 1% solution, acetic acid 2% spray (unlicensed) or clioquinol and a CC can be offered
otitis externa
In view of reports of ototoxicity, treatment with topical …… contraindicated in patients with perforated tympanic membrane (eardrum)
AGs
choice of abx therapy otitis externa
- If P. suspected: ciprofloxacin or an aminoglycoside
- No penicillin allergy: fluclox
- Penicillin allergy or intolerance: clarith (or azith or eryth)
what is otitis media
who is it common in
inflammation in middle ear associated with effusion and accompanied by ear infection
common in children
main causes of otitis media
generally viral
but both virus and bacteria often coexists
Children with acute otitis media usually present with symptoms such as
○ Ear pain
○ Rubbing of the ear
○ Fever
○ Irritability
○ Crying
○ Poor feeding
○ Restlessness at night
○ Cough
○ Rhinorrhoea
symptoms of otitis media usually resolve within
3-7 days wihtout abx
abx usually not required!!
what drug can you give for otitis media (not abx)
Consider offering ear drop containing anaesthetic and analgesic such as Otigo (phenazone with lidocaine), in addition to oral analgesics for pain relief, if immediate abx treatment not given and there is no eardrum perforation or otorrhoea
when to give abx for otitis media
not usually required
only give if systemically very unwell, or if otorrhoea present, or in children <2 with bilateral otitis media
what abx to give for otitis media
- 1st line amox
- 2nd line worsening symptoms despite 2-3d abx therapy: co-amoxiclav
- Allergy
- 1st line clarith or eryth (pregnancy)
- 2nd line worsening symptoms despite 2-3 days abx treatment: consult local microbiologist
what is otits media with effusion aka
glue ear
what is otitis media with effusion aka glue ear characterised by and who does it occur in and what does it commonly cause
- Characterised by collection of fluid within middle ear w/o any signs of inflammation or infection
- Most common in children, esp 6 months - 4 years
- Most common cause of hearing impairment in children
would you give treatment in pt with ototis media with effusion aka glue ear
Oral or topical abx, oral or nasal CCs, antihistamines, leukotriene receptor antagonists, mucolytics, decongestants are not recommended to treat due to lack of evidence
if OME with hearing loss, refer to specialist
if OME without hearing loss, reassure that it will resolve over time on its own wihtout treatment
Chronic suppurative otitis media
- Chronic inflammation of middle ear and mastoid cavity
- Thought to be a complication of acute otitis media
usual presentation of chronic supparative otitis media
- Usual presentation: otorrhoea through a tympanic perforation and can involve infection due to a number of different bacteria or fungi.
what to do if pt presents with chornic suppurative otitis media & what treatment would
- Can involve infection due to a number of different bacteria or fungi
- Referral to ENT specialist required
- Treatment likely to involve abx, CCs (usually topical) and intensive oral cleaning
in which scenario does ear wax need to be removed
- Only needs to be removed if it causes hearing loss or interferes with proper view of air drum
sodium bicarbonate drops are good for earwax removal but…
can cause dryness of air canal
how often to use ear drops to remove ear wax
The drops can be used three to four times daily for several days. Lying down with the affected ear uppermost, ear drops are instilled before waiting for 5 minutes.
when are ear drops e.g. olive oil, sodium chloride, sodium bicarbonate, almond oil not recommended
Ear drops are not recommended for patients suspected of having a perforated tympanic membrane, active dermatitis, or active infection of the ear canal.
