EAR INFECTIONS & MIDDLE EAR DISORDERS

Question 1

What are the etiology of otitis externa ?

Answer 1

*98% ar bacterial infections of P aeruginosa, S aureus and upto 1/3rd are polymicrobial.
* Aspergillus sp, Candida sp can also cause it
* Inflammatory and allergic skin disorder can also cause it.

Question 2

What are the risk factors for otitis externa ?

Answer 2

– Swimming
– Hx of a skin condition
– Ear trauma
– Hearing aids
– Cerumen buildup
– Warm, humid environments

Question 3

What is the clinical presentation of otitis externa ?

Answer 3

• Ear pain  deep “in the ear”
• Itching
• Oedema
• Manipulation of tragus or pinna is painful
• +/- fever

Question 4

What is the dx study in OE ?

Answer 4

Pneumatic otoscopy

Question 5

What is the indication of fungal OE during Pneumatic otoscopy?

Answer 5

Presence of hyphae and spores.

Question 6

What is malignant otitis Externa ?

Answer 6

– Extension into the surrounding soft tissues and Can extend into the CNS
The Risk Factors are DM and immunocompromised

Question 7

What is the duration of chronic otitis externa ?

Answer 7

> 3 months.

Question 8

what is the onset and duration of acute OE ?

Answer 8

– Onset over a 48-hour period
– Duration < 3 weeks

Question 9

What are the symptoms of otitis externa ?

Answer 9

– Ear pain
– Itching
– Fullness
– ± Hearing loss
– ± Jaw pain

Question 10

What are the signs of OE ?

Answer 10

– Tenderness of the tragus /
pinna
– Ear canal edema
– Ear canal erythema
– ± Otorrhoea
– ± Tympanic membrane
erythema
– ± Cellulitis of the pinna
– ± Local lymphadenitis

Question 11

What is the Tx of bacterial OE ?

Answer 11

Gentamicin + hydrocortisone for 3-7 days
OR.
Framycetin + gramicidin + dexamethasone for 3-7 days
OR
Neomycin + betamethasone for 3-7 days

Question 12

What is the Tx of fungal OE ?

Answer 12

Hydrocortisone/acetic acid otic, 3-5 drops into affected ear 3 times
daily for 7-10 days

Question 13

What is the Tx of malignant OE ?

Answer 13

Oral ciprofloxacin x 6-8 weeks +/- surgery

Question 14

What is the Tx of OE + TM perforation

Answer 14

Ciprofloxacin otic for 7 days

Question 15

What is the Tx of chronic OE ?

Answer 15

Investigate skin or allergic conditions, may need long course of ab

Question 16

What is the main cause of OM ?

Answer 16

Viral infections and bacterial overgrowth in the middle ear.

Question 17

What are the bacteria that cause OM in chidren < 3 months ?

Answer 17

1. E. coli
2. S. aureus

Question 18

What are the bacteria that cause OM in chidren 3 months -14 years ?

Answer 18

1. S. pneumoniae
2. H. influenzae
3. M. catarrhalis

Question 19

What are the bacteria that cause OM in people > 14 years ?

Answer 19

1. S. pneumoniae
2. Group A –hemolytic
   streptococci (GAS)
3. S. aureus

Question 20

What is the most frequent diagnosis in sick children at GP ?

Answer 20

Acute OM

Question 21

What are the vaccines in OM ?

Answer 21

PCV7 and PCV 13

Question 22

What are the symptoms of acute OM ?

Answer 22

– Headache
– Apathy
– Otalgia
– +/- Otorrhoea

Question 23

What are the signs of acute OM ?

Answer 23

– Fever
– Irritability
– Disturbed / restless sleep
– Poor feeding

Question 24

What are the PE findings in acute OM ?

Answer 24

– Decreased hearing
– Lateralization to affected ear
– BC > AC

Question 25

what are the changes seen in otoscopy of an ear tympanic membrane ?

Answer 25

– Color – pearly gray or pink / light red?
– Position – neutral, retracted or bulging?
– Mobility – brisk, none, slight movement?
– Perforation – intact, single perforation, multiple?

Question 26

What is the sensitivity and specificity of penumatic otoscopy in acute OM ?

Answer 26

90% Sensitive
– 80% Specific

Question 27

What are the extra otic finidings in acute OM PE ?

Answer 27

• Look for evidence of current or
  recent URTI
  – Scleral injection
  – Coryza
  – Pharyngeal erythema
  – Tonsillar swelling
  – Cervical lymphadenopathy
  – Skin rashes

Question 28

What are the Differential Diagnosis of acute OM ?

Answer 28

– Otitis externa
– Sinusitis
– Otitis media with effusion
– Eustachian tube dysfunction
– Cholesteatoma

Question 29

What are the symptoms of chronic OM ?

Answer 29

– Otalgia
– Aural fullness
– Decreased hearing
– Otorrhoea (often foul smelling)
– Flare up after URI or exposure to
water

Question 30

What are the PE findings in chronic OM ?

Answer 30

– TM perforation
– Polyp formation
– Cholesteatoma

Question 31

What is choesteatoma ?

Answer 31

It is tissue growth within middle ear due to recurrent OM. It Can erode tissue and bone and progress into CNS. Presents with painless otorrhoea and hearing loss. The Tx is excision.

Question 32

What are the obstructive etiologies of eustation tube dysfunction?

Answer 32

– Inflammation
– Pressure dysregulation
– Anatomy
– Degenerative

Question 33

What are the Patulous etiologies of eustation tube dysfunction?

Answer 33

– Allergic disease
– Weight loss
– Reflux
– Stress/Anxiety
– Dehydration
– Neuromuscular d/o
– Hormones
– Drugs

Question 34

What is the presentation of obstructive eustatian tube dysfunction ?

Answer 34

– Hearing loss
– TM Retractions
– Middle ear effusions

Question 35

What is the presentation of Patulous eustatian tube dysfunction ?

Answer 35

– Autophony
– Normal TMs

Question 36

What is the Tx of Patulous eustatian tube dysfunction ?

Answer 36

• Decongestants
• Systemic steroids
• Topical nasal steroids
• Politzer maneuver
• Surgery
  – Tympanostomy
  – Eustachian tuboplasty
  – Balloon dilation

Question 37

What is the Tx of obstructive eustatian tube dysfunction ?

Answer 37

• Hydration
• Tympanostomy tubes
• Intraluminal catheter
  placement
• Cartilage grafting
• Complete occlusion of ET with
  permanent tympanostomy