Ear Infections

Question 1

Otitis media refers to an infection of the middle ear. How does infection most commonly reach this area?

Is this infection most commonly bacterial or viral?

Answer 1

URTI which passes via the Eustachian tube into middle ear

Viral - haemophilus influenza

Question 2

Who does otitis media most commonly present in and why?

Answer 2

Kids/infants due to a shorter and more horizontal Eustachian tube

Question 3

Under what circumstances will otitis media present with discharge?

Answer 3

If tympanic membrane perforates

Question 4

Otitis media is normally self resolving. If it’s not, what antibiotics should be used?

What are the three other things that would signify use of antibiotics?

Answer 4

Amoxicillin/erthyomycin

Check antibiotic man

Bilateral
Bulging membrane
Discharge

Question 5

Who most commonly presents with otitis externa (infection of outer ear)?

Answer 5

Swimmers or those repeat exposure to H20

Question 6

What is the most common bacterial cause of otitis externa?

What other infective agent can cause it?

Answer 6

Staph aureus

Fungi

Question 7

Otitis media will present with otalgia.

How does this differ to otitis externa?

Answer 7

• Discharge
• Itchiness
• Redness, pain and swelling

Question 8

You must always swab for otitis externa. T/F?

Answer 8

F - only swab if persistent/severe

Question 9

How should otitis externa initally be managed?

Answer 9

Topical toilet - washout

Question 10

What can happen as a result of severe otitis externa?

What happens if this condition is left w/o treatment?

Answer 10

Malignant otitis - otitis externa that extends into the bone surrounding ear canal (mastoid and temporal bone)

Fatal w/o treatment - progresses to skull + meninges

Question 11

Patient presents with severe headache and new onset Bell’s palsy.

On inspection, exposed bone is present in ear canal.

What should be done next?

Answer 11

Malignant otitis

Imaging

Biopsy and culture to work out cause and extent

Question 12

What is the most common cause of malignant otitis?

As a result what antibiotic should be used?

Answer 12

Pseudomonas aeruginosa

Clarithromycin

Question 13

What are the 2 risk factors for malignant otitis?

Answer 13

1. Diabetes (90% of patients)

Radiotherapy to head and neck

Question 14

What is given AB wise for otitis externa?

Why is this more benefical than oral penicillin?

Answer 14

Topical gentamicin
+/-topical steroid too - if inflammed

Reduces ear oedema

Question 15

How is fungal otitis externa managed?

Answer 15

Topical clotrimazole

Question 16

The first thing to do with otitis media with effusion is watchful waiting. If that doesn’t work, what are steps 1 and 2 in treatment?

Answer 16

1. grommet insertion

2. adenoidectomy

Question 17

What is the most common cause of otitis media?

Answer 17

Haemophilus influenza