Ear pain Flashcards
What are the differentials for ear pain?
Otitis externa
foreign body
impacted cerumen
Otitis media
What is otitis externa and give the etiology?
- “Swimmer’s ear”
Etiology - N flora of external ear canal:
o CONS, Corynebacterium, micrococcus,
S.aureus, S.viridans, P.aeruginosa - P.aeruginosa, S.aureus, Enterobacter aerogenes,
proteus, klebsiella, streptococci, CONS, Candida,
aspergillus
What is the pathophysiology of otitis externa?
Patho
- Excessive wetness (swimming, bathing), dryness
(excessive ear cleaning), trauma, eczema make canal
susceptible to infection from N flora or other bacteria
What are the clinical manifestations of otitis externa?
CM
1. Acute raid onset ear pain (otalgia), severe
2. Aggravated by pinna manipulation or tragal pressure
and jaw motion
3. Itching – usually chronic OE/resolving
4. Conductive HL – edema of skin and TM, secretions
5. Acute: Edema of ear canal, erythema, clumpy otorrhea
6. Tender canal and swollen
7. Normal TM
8. Preauricular LNE
9. Erythema and swelling of pinna and periauricular skin
10. Necrotizing/malignant OE – facial paralysis, CN abN,
vertigo, SNHL
- Invasive infection of temporal bone and skull base
- Requires immediate C/S, abx, imaging
11. Otomycosis – fungal infection with fluffy white debris,
with black spores
How is otitis externa diagnosed?
clinical
Management of otitis externa
Mgt
1. Topical otic drops – ofloxacin, ciprofroxacin +
hydrocortisone/dexamethasone, acetic acid +
hydrocortisone, neomycin, polymyxin, HC
Fluocinolone + Polymyxin B + Neomycin otic drops 3-4
drops 2-3x/d x 10d
Ofloxacin otic drops 3-5 drops BID x 7-10d
2. Oral analgesics (pct, Ibu)
3. Otomycosis: clotrimazole 1% otic drops 2-3 drops
q8/12 x 14d or nystatin or gentian violet
4. Protect ears from excess water during bathing, avoid
swimming during infection
Prevention of otitis media
- Instill dilute alcohol or acetic acid or 1:1 mixture of
alcohol and white vinegar immediately after
swimming/bathing
What is the pathophysiology of impacted cerumen?
Cerumen: composed of keratin (desquamated
corneocytes), lipids (sebaceous glands – sat and unsat
Fam squalene, cholesterol, alcohol), peptides
(ceruminous glands)
Anatomic deformity, physical barriers to natural
cerumen extrusion (cotton swabs, hearing aids, earplugs)
–> inc cerumen impaction
What are the clinical manifestations of impacted cerumen?
CM
1. Otalgia (mild/moderate)
2. Fullness or feeling like your ear is plugged
3. Partial loss of hearing (worsening over time)
4. Ringing in your ear (tinnitus)
5. Coughing associated ear manipulation (not initially (+))
6. Itching, discharge, smell coming from the ears
What is the management of impacted cerumen?
Mgt
1. Mineral/ baby oil drops
2. Cerumenolytics – glycerine 10cc + 3% H2O2 10cc + 10%
Na bicarbonate 10 cc + distilled water 10cc
3. Do not use cotton swabs, or minimize to 2x/week.
- Pushes earwax deeper into the ear
- Slows down the natural process of earwax removal
- Injury to the eardrum
- Dislodgement of the cotton (FB)
Do not irrigate if with the ff:
- Perforated (or hx) eardrum
- Weak immune system, DM
- Tympanostomy tube
What are the common foreign body of the ear?
Etiopatho
- <6 yo
- most common object: beads, tissue paper, toys, insects
what are the clinical manifestations of foreign body in the ear?
CM
1. frequently asx’c
2. witnessed by parent/caregiver that a FB was placed in
the ear
3. incidental finding during routine otoscopy
4. dec hearing or ear pain
5. purulent or bloody ear discharge
What are the diagnostics for foreign body in the ear?
Dx
1. Visualization of FB in the EAC on otoscopy
2. Examine the other ear and nostrils for additional FBs
Management of foreign body in the ear
Mgt
1. Timing of removal
a. Depends on type of FB
b. Urgent removal for:
i. Button batteries: cause
destruction due to strong
chemical currents and P necrosis
ii. Insects: live insect may damage
TM and ME (cockroach)
iii. Penetrating FB: penetrate ME
structures
2. Elective referral to an ENT for asx’c patients with:
a. Spherical or other FB that is tightly wedged
in the medial EAC (round beads, paper,
rubber foam)
b. FB that is pushed up against the TM
c. FB not easily removed upon 1st attempt
d. Uncooperative pxs requiring sedation
What are the complications?
EAC abrasion/laceration: most common
Tx: topical abx ear drops: Ofloxacin otic drops 3-5
drops BID x 10d
