Ear Pain/ infections Flashcards
what is ottitis externa and how does it present
infection of the ear canal.
red, hot and painful external ear
itch
discharge
causes of ottitis externa
bacterial:
staph aureus
proteus
pseudomonas
fungal:
candida
aspergillum
treatment of ottitis externa
topical aural cleaning
acetic acid 2% tds until 2 days after its clear
swab if severe
clotrimazole - fungal
gentamicin - pseudomonas
what is ottitis media and how does it present
infection of the middle ear
proceeded by an URTI
crescendo-decrescendo pain (intense pain that does away once pus has drained)
reduced hearing in affected ear
discharge is tympanic membrane ruptures
causes of ottitis media
viral URTI secondary bacterial infection -h.influenza -strep pneumoniae - strep pyogenes
why is ottitis media common in kids
they have a short eustachian tube so infection can easily travel to ear
which bacteria causes chronic otitis media
pseudomonas
ottitis media treatment
usually resolves on its own
if severe/bilateral
- amoxicillin
what is ‘ glue ear’
ottitis media with effusion
conductive hearing loss in affected ear
often seen in kids 2-8 years
treatment of glue ear
monitor for 3 months then grommet insertion
what is malignant ottitis
when ottitis externa spreads into the surrounding bones of the ear canal causing osteomyelitis of the mastoid and temporal bones
can lead to meningitis
presentation of malignant ottitis
pain and headache
granulation tissue at bone/cartilage junction of ear canal
facial nerve palsy
most common cause of malignant ottitis
pseudomonas
malignant ottitis risk factors
diabetes
radiotherapy to head/neck
what is a cholesteatoma
presence of keratinised squamous epithelium in the middle ear (should be columnar)
the skin builds up and erodes the bones of the ear canal
high cell turn over
causes of cholesteatoma
chronic otitis media
perforation of tympanic membrane
treatment of cholesteatoma
do CT scan if suspicion
surgical excision and reconstruction needed
how does acute sinusitis present
discomfort over frontal/maxillary sinuses due to viral congestion
pain
tenderness
rhinorrhoea
treatment of acute sinusitis
if uncomplicated avoid antibiotics
if secondary bacterial infection (rare) give penicillin (2nd line - doxy)
most common cause of ear pain in adults
referred pain
which nerves cause referred pain to the ear
CNIX - glossopharyngeal
CNV3 - mandibular nerve
CNVII - facial nerve
CNX- vagus
C2,C3 spinal nerves
where does CNIX referred pain come from
(innervates pharynx and middle ear) - from tonsillitis, posterior 1/3 of the tongue
where does CNV3 referred pain come from
innervates outside of the tympanic membrane and tmj, salivary gland and tooth problems
where does CNX referred pain come from
piriform fossa/larynx
where does CNVII pain come from
pain from geniculate herpes, sphenoid damage, nasal pathology (Ramsay-hunt syndrome)
where does C2,C3 spinal nerve referred pain come from
cervical spondylosis
what is Ramsay- Hunt syndrome
shingles affecting the laical nerve causing facial pain and vesicles on the tympanic membrane or roof of mouth
