Ear Infections

Question 1

what is otitis externa

Answer 1

inflammation of the external ear canal

Question 2

presentation of otitis externa

Answer 2

ear pain
redness
itch
discharge

Question 3

most common infective organisms in otitis externa

Answer 3

staph aureus
pseudomonas – purulent discharge
fungal - aspergillus niger / candida

Question 4

what is malignant otitis externa

Answer 4

rare type of otitis externa caused by pseudomonas infection in diabetics / immunocompromised
infection begins in soft tissues and progresses to involve the bony ear canal

Question 5

presentation of malignant otitis externa

Answer 5

constant, severe ear pain
purulent discharge
temporal headache
facial nerve dysfunction

Question 6

complication of malignant otitis externa

Answer 6

temporal lobe osteomyelitis

Question 7

tx malignant otitis externa

Answer 7

IV ciprofloxacin

Question 8

tx of bacterial otitis externa

Answer 8

topical antimicrobial +/- corticosteroid

• neomycin
• acetic acid (otomize)
• ciprofloxacin for pseudomonas

Question 9

tx of fungal otitis externa

Answer 9

clotrimazole

Question 10

what it acute otitis media

Answer 10

inflammation of the middle ear

Question 11

what usually precedes otitis media

Answer 11

URTI

- extension of infection up the Eustachian tube

Question 12

symptoms of otitis media

Answer 12

ear pain
fever
inflamed, bulging ear drum seen with otoscope
– discharge + resolution of pain if eardrum bursts

Question 13

what type of hearing loss can you get with acute otitis media

Answer 13

conductive hearing loss

- fluid build up in middle ear impairs sound conduction to cochlea

Question 14

organisms in acute otitis media

Answer 14

mostly viral – H.Influenzae
secondary bacterial infection
– step pneumonia, strep pyogenes

Question 15

management of acute otitis media

Answer 15

80% resolve within 4 days and do not need antibiotics

use amoxicillin if

• symptoms persist >4 days
• if TM perforated
• bilateral OM <2 years old

Question 16

what is otitis media with effusion

Answer 16

build up of fluid behind the ear in the absence of infection

- know as ‘glue ear’

Question 17

appearance of ear drum in otitis media with effusion

Answer 17

retracted

Question 18

symptoms of otitis media with effusion

Answer 18

conductive hearing loss

behaviour problems / impaired speech in children

Question 19

tx of otitis media with effusion

Answer 19

watchful waiting - many will resolve

Grommet insertion to ventilate middle ear cavity + equalise pressure

Question 20

what is mastoiditis a complication of

Answer 20

acute otitis media

Question 21

presentation of mastoiditis

Answer 21

severe pain, tender, erythematous boggy mass overlying mastoid, protrusion of ear forwards

Question 22

why is mastoiditis an emergency

Answer 22

risk of meningitis

Question 23

management of mastoiditis

Answer 23

antibiotics

- mastoidectomy if no response

Question 24

management of a perforated tympanic membrane following otitis media

Answer 24

antibiotics

Question 25

management of perforated tympanic membrane following trauma

Answer 25

should heal within 6-8 weeks

- reassure patient

Question 26

surgical procedure if tympanic membrane fails to heal on its own

Answer 26

myringoplasty