Ear Infections An Overview Flashcards
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
What are the common ear infections of the middle ear
Acute otitis media
Chrinic otitis media
What is Otitis externa
This is the inflammation of the ear from the pinna to the epidermal layer of the tympanic membrane.
What are the common causes of perichondritis?
Piercing
Surgical procedure
Lacerations
Canal infections
What are the common causative agent of perichondritis
Staphylococcus aureus
Pseudomonas
What are the symptoms of perichondritis?
Hot
Painful
Swollen pinna
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)
What is the causative agent for localized otitis externa
Staphylococcus infection of hair follicles.
Usually due to habitual ear cleaning/probing
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)
What are the treatment options for localized otitis externa?
- Broad spectrum antibiotics
- Anti-inflammatory drugs
- Antibiotic ear drops (cipro, neomycin, steroids)
- Suction if ruptured
Which form of otitis externa is called swimmers ear
Diffuse Otitis Externa
What are the causative agents of diffuse otitis externa?
Staphylococcus aureus
Escherichia coli
B. proteus
Pseudomonas pyoganeus
What are the symptoms of diffuse otitis externa?
Hot, heavy, painful ears with discharge
Itching
Jaw movement pain
How do you differentiate the pain of otitis externa from the pain of otitis media
TRAGAL PAIN - Otitis externa
PINNAL PAIN - Otitis media
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
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
