EAR INFECTIONS & MIDDLE EAR DISORDERS Flashcards
What are the etiology of otitis externa ?
*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.
What are the risk factors for otitis externa ?
– Swimming
– Hx of a skin condition
– Ear trauma
– Hearing aids
– Cerumen buildup
– Warm, humid environments
What is the clinical presentation of otitis externa ?
- Ear pain deep “in the ear”
- Itching
- Oedema
- Manipulation of tragus or pinna is painful
- +/- fever
What is the dx study in OE ?
Pneumatic otoscopy
What is the indication of fungal OE during Pneumatic otoscopy?
Presence of hyphae and spores.
What is malignant otitis Externa ?
– Extension into the surrounding soft tissues and Can extend into the CNS
The Risk Factors are DM and immunocompromised
What is the duration of chronic otitis externa ?
> 3 months.
what is the onset and duration of acute OE ?
– Onset over a 48-hour period
– Duration < 3 weeks
What are the symptoms of otitis externa ?
– Ear pain
– Itching
– Fullness
– ± Hearing loss
– ± Jaw pain
What are the signs of OE ?
– Tenderness of the tragus /
pinna
– Ear canal edema
– Ear canal erythema
– ± Otorrhoea
– ± Tympanic membrane
erythema
– ± Cellulitis of the pinna
– ± Local lymphadenitis
What is the Tx of bacterial OE ?
Gentamicin + hydrocortisone for 3-7 days
OR.
Framycetin + gramicidin + dexamethasone for 3-7 days
OR
Neomycin + betamethasone for 3-7 days
What is the Tx of fungal OE ?
Hydrocortisone/acetic acid otic, 3-5 drops into affected ear 3 times
daily for 7-10 days
What is the Tx of malignant OE ?
Oral ciprofloxacin x 6-8 weeks +/- surgery
What is the Tx of OE + TM perforation
Ciprofloxacin otic for 7 days
What is the Tx of chronic OE ?
Investigate skin or allergic conditions, may need long course of ab
What is the main cause of OM ?
Viral infections and bacterial overgrowth in the middle ear.
What are the bacteria that cause OM in chidren < 3 months ?
- E. coli
- S. aureus
What are the bacteria that cause OM in chidren 3 months -14 years ?
- S. pneumoniae
- H. influenzae
- M. catarrhalis
What are the bacteria that cause OM in people > 14 years ?
- S. pneumoniae
- Group A –hemolytic
streptococci (GAS) - S. aureus
What is the most frequent diagnosis in sick children at GP ?
Acute OM
What are the vaccines in OM ?
PCV7 and PCV 13
What are the symptoms of acute OM ?
– Headache
– Apathy
– Otalgia
– +/- Otorrhoea
What are the signs of acute OM ?
– Fever
– Irritability
– Disturbed / restless sleep
– Poor feeding
What are the PE findings in acute OM ?
– Decreased hearing
– Lateralization to affected ear
– BC > AC
what are the changes seen in otoscopy of an ear tympanic membrane ?
– Color – pearly gray or pink / light red?
– Position – neutral, retracted or bulging?
– Mobility – brisk, none, slight movement?
– Perforation – intact, single perforation, multiple?
What is the sensitivity and specificity of penumatic otoscopy in acute OM ?
90% Sensitive
– 80% Specific
What are the extra otic finidings in acute OM PE ?
- Look for evidence of current or
recent URTI
– Scleral injection
– Coryza
– Pharyngeal erythema
– Tonsillar swelling
– Cervical lymphadenopathy
– Skin rashes
What are the Differential Diagnosis of acute OM ?
– Otitis externa
– Sinusitis
– Otitis media with effusion
– Eustachian tube dysfunction
– Cholesteatoma
What are the symptoms of chronic OM ?
– Otalgia
– Aural fullness
– Decreased hearing
– Otorrhoea (often foul smelling)
– Flare up after URI or exposure to
water
What are the PE findings in chronic OM ?
– TM perforation
– Polyp formation
– Cholesteatoma
What is choesteatoma ?
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.
What are the obstructive etiologies of eustation tube dysfunction?
– Inflammation
– Pressure dysregulation
– Anatomy
– Degenerative
What are the Patulous etiologies of eustation tube dysfunction?
– Allergic disease
– Weight loss
– Reflux
– Stress/Anxiety
– Dehydration
– Neuromuscular d/o
– Hormones
– Drugs
What is the presentation of obstructive eustatian tube dysfunction ?
– Hearing loss
– TM Retractions
– Middle ear effusions
What is the presentation of Patulous eustatian tube dysfunction ?
– Autophony
– Normal TMs
What is the Tx of Patulous eustatian tube dysfunction ?
- Decongestants
- Systemic steroids
- Topical nasal steroids
- Politzer maneuver
- Surgery
– Tympanostomy
– Eustachian tuboplasty
– Balloon dilation
What is the Tx of obstructive eustatian tube dysfunction ?
- Hydration
- Tympanostomy tubes
- Intraluminal catheter
placement - Cartilage grafting
- Complete occlusion of ET with
permanent tympanostomy
