Ear Infections An Overview

Question 1

What are the common ear infections of the external ear

Answer 1

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

Question 2

What are the common ear infections of the middle ear

Answer 2

Acute otitis media
Chrinic otitis media

Question 3

What is Otitis externa

Answer 3

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

Question 4

What are the common causes of perichondritis?

Answer 4

Piercing
Surgical procedure
Lacerations
Canal infections

Question 5

What are the common causative agent of perichondritis

Answer 5

Staphylococcus aureus
Pseudomonas

Question 6

What are the symptoms of perichondritis?

Answer 6

Hot
Painful
Swollen pinna

Question 7

What is the treatment option for perichondritis

Answer 7

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

Question 8

What is the causative agent for localized otitis externa

Answer 8

Staphylococcus infection of hair follicles.

Usually due to habitual ear cleaning/probing

Question 9

What are the symptoms of localized otitis externa

Answer 9

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

Question 10

What are the treatment options for localized otitis externa?

Answer 10

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

Question 11

Which form of otitis externa is called swimmers ear

Answer 11

Diffuse Otitis Externa

Question 12

What are the causative agents of diffuse otitis externa?

Answer 12

Staphylococcus aureus
Escherichia coli
B. proteus
Pseudomonas pyoganeus

Question 13

What are the symptoms of diffuse otitis externa?

Answer 13

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

Question 14

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

Answer 14

TRAGAL PAIN - Otitis externa
PINNAL PAIN - Otitis media

Question 15

What are the treatment options for diffuse otitis externa?

Answer 15

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

Question 16

What is another name for fungal otitis externa?

Answer 16

OTOMYCOSIS

Question 17

What are the causative agents of fungal otitis externa?

Answer 17

Candida
Aspergillus

Question 18

What are the symptoms of otomycosis?

Answer 18

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

On examination;
BLACK SPOTS - Aspergillus
WHITE SPOTS - Candida

Question 19

What are the treatment options for fungal otitis externa

Answer 19

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

Question 20

What is another name for malignant otitis externa

Answer 20

Necrotizing otitis externa

Commonly seen in diabetic, elderly and immunosuppressed patients

Question 21

What are the causative agents for malignant otitis externa

Answer 21

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

MPaEcSa

Question 22

What are the symptoms of malignant otitis externa

Answer 22

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

Question 23

What are the treatment options for malignant otitis externa

Answer 23

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

Question 24

What is the causative agent for herpes zoster oticus

Answer 24

Varicella zoster infection

Question 25

What are the symptoms of herpes zoster oticus?

Answer 25

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

Question 26

What is Otitis Media

Answer 26

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

Question 27

List the common bacterial causes of Otitis media

Answer 27

Streptococcus pneumoniae Hemophilus influenza Moraxella catarrhalis

Question 28

List the common viral causes of Otitis media

Answer 28

Respiratory Syncytial Virus (RSV) Coronavirus Rhinovirus

Question 29

What are the risk factors for developing otitis media

Answer 29

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

Question 30

Pathophysiology of otitis media

Answer 30

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.

Question 31

What are the clinical presentations of acute otitis media

Answer 31

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

Question 32

What is Chronic Otitis Media

Answer 32

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

Question 33

The factors that predispose someone to Chronic Otitis Media

Answer 33

Poorly managed ASOM Low socioeconomic class Immunosupression

Question 34

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

Answer 34

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.

Question 35

Differentiate between tubotympanic and atticoantral chronic otitis media.

Answer 35

**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

Question 36

What are the causative agent for chronic Otis media

Answer 36

Pseudomonas aeruginosa Staphylococcus aureus Escherichia coli

Question 37

Treatment options for chronic otitis media

Answer 37

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

Question 38

How to differentiate Acute otitis externa from Acute otitis media

Answer 38

**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