ear infections

Question 1

what is otitis externa

Answer 1

Inflammation of external ear canal, in some cases can involve oedema
aka swimmers ear

Question 2

otitis externa can be triggered by bacterial infection caused by (2)

Answer 2

P. aeruginosa or S. aureus

Question 3

Important to consider underlying otitis media as otitis externa may be secondary to…

Answer 3

otorrhoea from otitis media

Question 4

are abx needed for otitis externa

Answer 4

• Oral abx rarely indicated, but if required, consider seeking specialist advice

Question 5

what product can you give for otitis externa

Answer 5

• 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

Question 6

If a mild to moderate, uncomplicated fungal infection suspected in the context of chronic otitis externa, what can you give

Answer 6

topical antifungal such as clotrimazole 1% solution, acetic acid 2% spray (unlicensed) or clioquinol and a CC can be offered

Question 7

otitis externa
In view of reports of ototoxicity, treatment with topical …… contraindicated in patients with perforated tympanic membrane (eardrum)

Answer 7

AGs

Question 8

choice of abx therapy otitis externa

Answer 8

• If P. suspected: ciprofloxacin or an aminoglycoside
  
  • No penicillin allergy: fluclox
  • Penicillin allergy or intolerance: clarith (or azith or eryth)

Question 9

what is otitis media

who is it common in

Answer 9

inflammation in middle ear associated with effusion and accompanied by ear infection

common in children

Question 10

main causes of otitis media

Answer 10

generally viral
but both virus and bacteria often coexists

Question 11

Children with acute otitis media usually present with symptoms such as

Answer 11

○ Ear pain
○ Rubbing of the ear
○ Fever
○ Irritability
○ Crying
○ Poor feeding
○ Restlessness at night
○ Cough
○ Rhinorrhoea

Question 12

symptoms of otitis media usually resolve within

Answer 12

3-7 days wihtout abx
abx usually not required!!

Question 13

what drug can you give for otitis media (not abx)

Answer 13

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

Question 14

when to give abx for otitis media

Answer 14

not usually required
only give if systemically very unwell, or if otorrhoea present, or in children <2 with bilateral otitis media

Question 15

what abx to give for otitis media

Answer 15

• 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

Question 16

what is otits media with effusion aka

Answer 16

glue ear

Question 17

what is otitis media with effusion aka glue ear characterised by and who does it occur in and what does it commonly cause

Answer 17

• 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

Question 18

would you give treatment in pt with ototis media with effusion aka glue ear

Answer 18

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

Question 19

Chronic suppurative otitis media

Answer 19

• Chronic inflammation of middle ear and mastoid cavity
  
  • Thought to be a complication of acute otitis media

Question 20

usual presentation of chronic supparative otitis media

Answer 20

• Usual presentation: otorrhoea through a tympanic perforation and can involve infection due to a number of different bacteria or fungi.

Question 21

what to do if pt presents with chornic suppurative otitis media & what treatment would

Answer 21

• 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

Question 22

in which scenario does ear wax need to be removed

Answer 22

• Only needs to be removed if it causes hearing loss or interferes with proper view of air drum

Question 23

sodium bicarbonate drops are good for earwax removal but…

Answer 23

can cause dryness of air canal

Question 24

how often to use ear drops to remove ear wax

Answer 24

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.

Question 25

when are ear drops e.g. olive oil, sodium chloride, sodium bicarbonate, almond oil not recommended

Answer 25

Ear drops are not recommended for patients suspected of having a perforated tympanic membrane, active dermatitis, or active infection of the ear canal.