Ear Infections An Overview Flashcards by Emmanuel Eya

What are the common ear infections of the external ear

Perichondritis
Localized otitis externa
Diffuse otitis externa
Fungal otitis externa
Malignant otitis externa
Herpes zoster oticus

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What are the common ear infections of the middle ear

Acute otitis media
Chrinic otitis media

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What is Otitis externa

This is the inflammation of the ear from the pinna to the epidermal layer of the tympanic membrane.

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What are the common causes of perichondritis?

Piercing
Surgical procedure
Lacerations
Canal infections

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What are the common causative agent of perichondritis

Staphylococcus aureus
Pseudomonas

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What are the symptoms of perichondritis?

Hot
Painful
Swollen pinna

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What is the treatment option for perichondritis

Broad spectrum antibiotic
Anti-inflammatory drugs (NSAIDS)
Cold compress
Aluminum citrate (dries a weeping ear)
Irrigation and drainage (for abscess formation)

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What is the causative agent for localized otitis externa

Staphylococcus infection of hair follicles.

Usually due to habitual ear cleaning/probing

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What are the symptoms of localized otitis externa

Severe pain worsened by jaw movement
Little or no discharge
Usually single boils (multiple boils is seen in immunosuppression)

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What are the treatment options for localized otitis externa?

Broad spectrum antibiotics
Anti-inflammatory drugs
Antibiotic ear drops (cipro, neomycin, steroids)
Suction if ruptured

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Which form of otitis externa is called swimmers ear

Diffuse Otitis Externa

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What are the causative agents of diffuse otitis externa?

Staphylococcus aureus
Escherichia coli
B. proteus
Pseudomonas pyoganeus

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What are the symptoms of diffuse otitis externa?

Hot, heavy, painful ears with discharge
Itching
Jaw movement pain

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How do you differentiate the pain of otitis externa from the pain of otitis media

TRAGAL PAIN - Otitis externa
PINNAL PAIN - Otitis media

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What are the treatment options for diffuse otitis externa?

Ear swab (for m/c/s)
Otowick antibiotic dressing
Broad spectrum antibiotics
Analgesics & NSAIDS
Avoid ear probing

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What is another name for fungal otitis externa?

OTOMYCOSIS

What are the causative agents of fungal otitis externa?

Candida
Aspergillus

What are the symptoms of otomycosis?

Intense itching (1st symptom)
Pain
Sensation of fullness
Ear blocking
Scanty watery discharge

On examination;
BLACK SPOTS - Aspergillus
WHITE SPOTS - Candida

What are the treatment options for fungal otitis externa

Ear swab (for m/c/s)
Ear syringing
Anti fungal drops (via otowick dressing)
Systemic antifungal
Counsel on keeping ears dry
Prevent ear cleaning

What is another name for malignant otitis externa

Necrotizing otitis externa

Commonly seen in diabetic, elderly and immunosuppressed patients

What are the causative agents for malignant otitis externa

Pseudomonas aeruginosa (commonest)
Escherichia coli
Staphylococcus aureus

MPaEcSa

What are the symptoms of malignant otitis externa

Deep excruciating pain (nocturnal)
Multiple CN palsy (5,7,9,10,11,12)

What are the treatment options for malignant otitis externa

Admit
Monitor and control blood sugar
Ear swab (m/c/s)
Aural toileting
Debride
Antibiotic ear drop (otowick mgmt)
IV antibiotics for 6 weeks
Anti-inflammatory drugs

NB:- mgmt is multidisciplinary involving ENT, Endocrinology and Neurosurgery

What is the causative agent for herpes zoster oticus

Varicella zoster infection

What are the symptoms of herpes zoster oticus?

External ear rash Facial weakness (facial nerve palsy from Ramsey Hunt Syndrome) Otalgia (ear pain)

What is Otitis Media

This is the acute inflammation of the mucosa of the middle ear

List the common bacterial causes of Otitis media

Streptococcus pneumoniae Hemophilus influenza Moraxella catarrhalis

List the common viral causes of Otitis media

Respiratory Syncytial Virus (RSV) Coronavirus Rhinovirus

What are the risk factors for developing otitis media

Low socioeconomic state Recurrent URTI Exposure to indoor smoking Recumbent breastfeeding Allergy

Pathophysiology of otitis media

It can arise from 1) Otitis externa 2) Eustachian tube (commonest) 3) Blood borne EUSTACHIAN TUBE ORIGIN - **TUBAL OCCLUSION** Recurrent URTI, recumbent breastfeeding etc can cause blockage of the Eustachian tube and subsequent inflammatory response. - **PRE-SUPPURATION** Inflammation leads to build up of pus within the tube but no leakage at this stage. They present with pain, possible fever and feeling of fullness. -**SUPPURATION** There is a tear in the middle ear due to pus accumulation leading to leakage of pus from the middle ear. There is also resolution of pain and fever at this stage. -**RESOLUTION** Either with medical intervention or spontaneously, the ear drum will adapt (heal) with the tear and this stops the condition. -**COMPLICATION** When pus occludes the tear in the ear drum or if there is no spontaneous resolution, there will be more buildup of pus in the middle ear leading to a spread of infection past the middle ear to cause complications like meningitis, brain abscess etc.

What are the clinical presentations of acute otitis media

- Deep throbbing otalgia - Aural fullness - Leakage of pus with resolution of fever and pain - Tinnitus - Might have coexisting URTI - Irritability with ear tugging

What is Chronic Otitis Media

This is the failure of resolution of acute otitis media with permanent damage to the tympanic membrane and or presence of granulation tissue from the middle ear. OR Acute Suppurative Otitis Media > 3wks

The factors that predispose someone to Chronic Otitis Media

Poorly managed ASOM Low socioeconomic class Immunosupression

Based on the section of the tympanic membrane that is damaged, classify chronic otitis media

1) **Tubotympanic (pas tensa):-** Affects lower 2/3 rd of the ear drum. 2) **Atticoantral (pas flaccida):-** Affects the upper 1/3 rd of the ear drum.

Differentiate between tubotympanic and atticoantral chronic otitis media.

**PAS TENSA** better *DISCHARGE* Profuse, mucoid, odorless *PERFORATION* Central *GRANULATION* Uncommon *POLYP* Pale *CHOLESTEATOMA* Absent *COMPLICATIONS* Rare *AUDIOGRAM* Mild - moderate conductive deafness **PAS FLACCIDA** worse *DISCHARGE* Scanty, purulent, foul smelling *PERFORATION* Attic or marginal *GRANULATION* Common *POLYP* Red and fleshy *CHOLESTEATOMA* Present *COMPLICATIONS* Common *AUDIOGRAM* Conductive or mixed deafness

What are the causative agent for chronic Otis media

Pseudomonas aeruginosa Staphylococcus aureus Escherichia coli

Treatment options for chronic otitis media

Aural toileting Keep ear dry Antibiotic ear drop (otowick dressing) Systemic antibiotics Surgery (Craniotomy, Mastoidectomy)

How to differentiate Acute otitis externa from Acute otitis media

**EXTERNA** 1) pain is superficial and exacerbated by jaw movement 2) pinnal and tragal pain is present 3) discharge is usually scanty and watery/purulent 4) tympanic membrane is intact **MEDIA** 1) pain is deep and throbbing, non-radiating 2) pinnal and tragal pain are usually absent 3) discharge is mucopurulent 4) tympanic membrane is perforated