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Surgery > Ear Infections An Overview > Flashcards

Ear Infections An Overview Flashcards

1
Q

What are the common ear infections of the external ear

A

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

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2
Q

What are the common ear infections of the middle ear

A

Acute otitis media
Chrinic otitis media

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3
Q

What is Otitis externa

A

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

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4
Q

What are the common causes of perichondritis?

A

Piercing
Surgical procedure
Lacerations
Canal infections

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5
Q

What are the common causative agent of perichondritis

A

Staphylococcus aureus
Pseudomonas

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6
Q

What are the symptoms of perichondritis?

A

Hot
Painful
Swollen pinna

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7
Q

What is the treatment option for perichondritis

A
  • 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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8
Q

What is the causative agent for localized otitis externa

A

Staphylococcus infection of hair follicles.

Usually due to habitual ear cleaning/probing

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9
Q

What are the symptoms of localized otitis externa

A
  • Severe pain worsened by jaw movement
  • Little or no discharge
  • Usually single boils (multiple boils is seen in immunosuppression)
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10
Q

What are the treatment options for localized otitis externa?

A
  • Broad spectrum antibiotics
  • Anti-inflammatory drugs
  • Antibiotic ear drops (cipro, neomycin, steroids)
  • Suction if ruptured
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11
Q

Which form of otitis externa is called swimmers ear

A

Diffuse Otitis Externa

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12
Q

What are the causative agents of diffuse otitis externa?

A

Staphylococcus aureus
Escherichia coli
B. proteus
Pseudomonas pyoganeus

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13
Q

What are the symptoms of diffuse otitis externa?

A

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

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14
Q

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

A

TRAGAL PAIN - Otitis externa
PINNAL PAIN - Otitis media

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15
Q

What are the treatment options for diffuse otitis externa?

A

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

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16
Q

What is another name for fungal otitis externa?

A

OTOMYCOSIS

17
Q

What are the causative agents of fungal otitis externa?

A

Candida
Aspergillus

18
Q

What are the symptoms of otomycosis?

A

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

On examination;
BLACK SPOTS - Aspergillus
WHITE SPOTS - Candida

19
Q

What are the treatment options for fungal otitis externa

A
  • Ear swab (for m/c/s)
  • Ear syringing
  • Anti fungal drops (via otowick dressing)
  • Systemic antifungal
  • Counsel on keeping ears dry
  • Prevent ear cleaning
20
Q

What is another name for malignant otitis externa

A

Necrotizing otitis externa

Commonly seen in diabetic, elderly and immunosuppressed patients

21
Q

What are the causative agents for malignant otitis externa

A
  • Pseudomonas aeruginosa (commonest)
  • Escherichia coli
  • Staphylococcus aureus

MPaEcSa

22
Q

What are the symptoms of malignant otitis externa

A

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

23
Q

What are the treatment options for malignant otitis externa

A

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

24
Q

What is the causative agent for herpes zoster oticus

A

Varicella zoster infection

25
Q

What are the symptoms of herpes zoster oticus?

A

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

26
Q

What is Otitis Media

A

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

27
Q

List the common bacterial causes of Otitis media

A

Streptococcus pneumoniae
Hemophilus influenza
Moraxella catarrhalis

28
Q

List the common viral causes of Otitis media

A

Respiratory Syncytial Virus (RSV)
Coronavirus
Rhinovirus

29
Q

What are the risk factors for developing otitis media

A

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

30
Q

Pathophysiology of otitis media

A

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.

31
Q

What are the clinical presentations of acute otitis media

A
  • Deep throbbing otalgia
  • Aural fullness
  • Leakage of pus with resolution of fever and pain
  • Tinnitus
  • Might have coexisting URTI
  • Irritability with ear tugging
32
Q

What is Chronic Otitis Media

A

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

33
Q

The factors that predispose someone to Chronic Otitis Media

A

Poorly managed ASOM
Low socioeconomic class
Immunosupression

34
Q

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

A

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.

35
Q

Differentiate between tubotympanic and atticoantral chronic otitis media.

A

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

36
Q

What are the causative agent for chronic Otis media

A

Pseudomonas aeruginosa
Staphylococcus aureus
Escherichia coli

37
Q

Treatment options for chronic otitis media

A

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

38
Q

How to differentiate Acute otitis externa from Acute otitis media

A

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

Surgery (29 decks)

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