Ear pain Flashcards
Of patients presenting with earache, 77% can be expected to have ____ and 12% ___
acute otitis media
otitis externa.
Otitis media is unlikely to be present if the
__________
tympanic membrane (TM) is mobile.
_______ greatly assists diagnosis since the most valuable sign of otitis media is absent or diminished motility of the TM
Pneumatic otoscopy
________ which causes haemorrhagic blistering of the eardrum or external ear canal, is an uncommon cause of severe pain. It is caused by a virus, probably influenza
Bullous myringitis,
The antibiotic of first choice for acute otitis media (children and adults) is _______
amoxycillin
Otitis externa can be distinguished from otitis
media by ________
pain on movement of the pinna
Red flags for painful ear
• Offensive discharge >9 days • Downward displacement of pinna • Swelling behind ear • Neurological symptoms (e.g. headaches, drowsiness) • Older person: unexplained, intractable ear pain • Persistent fever
Disorders of the _______ are a
commonly overlooked cause of periotic pain
upper cervical spine
movement of the jaw usually causes an exacerbation of ______
TMJ arthralgia or severe otitis externa.
T or F
Impacted wax may not explain the otalgia.
T
Swabs from discharge, especially to determine bacterial causes, such as _____ or _______
Staphylococcus aureus or
Pseudomonas spp. infection
How to extract foreign bodies. What methods?
1
2
Probe method
Rubber catheter suction method
The only equipment required for this relatively simple and painless method is a ________
straight rubber catheter (large
type) and perhaps a suction pump
Persistent middle ear effusions may follow
and affect the _____ and _______
language and cognitive development of
young children
2 peaks of otitis media in children
6–12 months of age and
school entry
MC cause of otitis media in children
Streptococcus pneumoniae,
Haemophilus influenzae and
Moraxella catarrhalis
The main symptomsof otitis media in older children are ____ and ______
increasing earache and hearing loss
Possible clinical indications for antibiotics
in children with painful otitis media
• <2 years with bilateral otitis media • Sick child with fever • Vomiting • Red–yellow bulging TM • Loss of TM landmarks or perforation • Persistent fever and pain after 48 hours conservative approach • Risk of complications in those at risk
______ is also the preferred choice of otitis media in the US and UK
Amoxycillin
With appropriate treatment most children with
acute otitis media are significantly improved within ________
48 hours
A randomised trial has found that _________are superior to oral antibiotics for the treatment of acute otorrhoea in children with grommets
antibiotic eardrops
Cx of otitis media
1
2
3
Middle ear effusion
Acute mastoiditis
Chronic suppurative otitis media
WHat to do if effusion is still present at 6–8 weeks
a second
course of antibiotics should be prescribed
This is a major complication that presents with pain, swelling and tenderness
developing behind the ear associated with a
general deterioration in the condition of the
child
Acute mastoiditis
Discharge through a perforation of the TM >6 weeks
Chronic suppurative otitis media
Rare Cx of otitis media
labyrinthitis, petrositis, facial paresis and intracranial abscess
This represents
incomplete resolution of suppurative otitis
media.
Serous otitis media (glue ear).
Serous otitis media (glue ear). signs
loss of drum mobility,
hearing loss and
abnormal impedance confirmed
by pneumatic otoscopy or tympanometry
a proposed_____ and ________ may be an effective preventive
measure for childhood otitis media
S. pneumoniae and H. influenzae
conjugate vaccine
Define recurrent OM
it occurs more often than every other
month or for three or more episodes in 6 months or >4 in 12 months:
How to Tx recurrent OM
chemoprophylaxis (for about 4 months)
amoxycillin twice daily (first choice)
or
cefaclor twice daily
The commonest organisms for acute OM in the elderly
viruses (adenovirus and enterovirus), and the bacteria H. influenzae, S. pneumoniae, Moraxella (previously Neisseria catarrhalis ) and β -haemolytic streptococci
The two cardinal features of diagnosis acute OM in the elderly are
inflammation and middle ear effusion
T or F
If the middle ear structures are clearly
visible through the drum, otitis media is likely
F
Likely
The normal TM is a shiny pale-grey to
brown: a yellow colour is suggestive of an _________
effusion.
In acute OM,
The inflammatory process usually begins in the _________
upper posterior quadrant and spreads peripherally and down the handle of the malleus
Late sign of acute OM
Bulging of the drum is a late sign
Treatment of acute otitis media (adults)
• Analgesics to relieve pain
• Adequate rest in a warm room
• Nasal decongestants for nasal congestion
• Antibiotics until resolution of all signs of infection
• Treat associated conditions (e.g. adenoid
hypertrophy
First choice of abx in pts on OM:
amoxycillin 750 mg (o) bd for 5 days 7
or
500 mg (o) tds for 5 days
Abx duration of acute otitis media (adults)
longer course (up to 10 days) may be required depending on severity and response to 5-day course.
alternative to Amox in OM
doxycycline 100 mg (o) bd for 5–7 days (daily for milder infections)
or
cefaclor 250 mg (o) tds for 5–7 days
if with resistance to Amox in OM
or (if resistance to amoxycillin is suspected or proven) amoxycillin/potassium clavulanate 500/125 mg (o) tds for 5 days (the most effective antibiotic)
How to tx CSOM
If aural discharge persists for >6 weeks after course of antibiotics, treatment can be with topical steroid and antibiotic combination drops, following ear toilet
Red flags for cholesteatoma include
1
2
3
meningitis type features,
cranial nerve deficits, sensorineural
hearing loss and persistent deep ear pain
Characteristics of unsafe dc
Cholesteatoma source
Foul
Usually scant, never profuse
Purulent
Characteristics of safe dc
Mucosa source
Can be profuse amount
Mucopurulent nature
also known as ‘swimmer’s ear’, ‘surfer’s ear’ and ‘tropical ear’, is common in a country whose climate and coastal living
leads to extensive water sports.
Otitis externa
Common bacteria causing otitis externa
— Pseudomonas sp. — Escherichia coli — S. aureus — Proteus sp. — Klebsiella sp.
Common fungi causing otitis externa
— Candida albicans
— Aspergillus sp.
Malignant’ otitis externa occurs in _____
due to Pseudomonas infection at base of skull.
diabetics
MX of otitis externa
Aural toilet
Syringing
Dressings
Topical antimicrobals
This severe complication usually due to Pseudomonas aeruginosa can occur in the immunocompromised, diabetic or elderly patient
Necrotising otitis externa
These periosteal bony overgrowths are usually caused by water retention in the ear. They are often multiple. They tend to trap keratin, wax and water, leading to infection
Ear exostoses (‘surfer’s ear’)
_______ is a staphylococcal infection of the hair follicle in the outer cartilaginous part of the ear canal. It is usually intensely painfu
Furunculosis
_________ is infection of the cartilage of the ear characterised by severe pain of the pinna, which is red, swollen and exquisitely tender
Perichondritis
Organisms for perichondrtitis
P. pyocaneus
Infected ear lobe
The cause is most likely a contact allergy to nickel in an earring, complicated by a_____
S. aureus infection
This is a common cause of discomfort. Symptoms include fullness in the ear, pain of various levels and impairment of hearing
Eustachian tube dysfunction
Common causes of tubal dysfunction
oedema of the tubal lining, such as viral URTI and allergy when the tube
is only partially blocked
MX of Eustachian tube dysfunction
Systemic and intranasal decongestants
Autoinflation by forced exhalation against closed nostrils
_____ is damage caused by undergoing rapid changes in atmospheric pressure in the presence of an occluded Eustachian tube
Barotrauma
Barotrauma Signs
(in order of seriousness):
retraction; erythema; haemorrhage (due
to extravasation of blood into the layers of the TM); fluid or blood in the middle ear; perforation
Consider_________ if foul-smelling discharge is present over 7 + days
mastoiditis
