Earache Flashcards
ACUTE OTITIS MEDIA
i) which group is it most common in?
ii) what may it be preceeded by? why? name two bacteria it may be second to
iii) name three symptoms that may be seen? what can be seen if the tympanic membrane perforates?
iv) name three things that may be seen on otoscopy?
v) name three things where the prescence may indicator OM?
i) common in young children under 3
ii) may be preceeded by a viral upper resp tract infection but most are due to bacteria eg strep pneumoniae or hamophilus influenzae
iii) ear ache, fever, hearing loss, recent viral URTI or ear discharge if the tympanic membrane perforates
iv) otoscopy - bulging tympanic membrane and loss of light reflex, opacification/erythema of tympanic membrane, perforation,
v) acute onset of symptoms, presence of middle ear effusion, inflammation of tympanic membrane
ACUTE OTITIS MEDIA TX
i) how does it usually progress? does it usually need abx?
ii) what supportive tx can be given
iii) name four scenarios when abx should be given
iv) what abx is first line? what is given in penecillin allergy?
v) name three common seqalae
i) usually self limiting and doesnt need abx
ii) anaglesia
iii) symptoms >4d and not improving, systemically unwell. immunocompromised, younger than 2 with bilateral disease, peforation
iv) give amoxicillin or erythro/clarithro
v) perforation of tympanic membrane with otorrhea (ear discharge), hearing loss, labrynthitis
OTITIS EXTERNA
i) what is it? name three common causes? name two causative bacteria
ii) name three symptoms? name two things that may be seen on otoscopy
iii) what is first line tx? what is not given if the tympanic membrane is perforated?
iv) name three second line txs? what should be done if the patient is not improving?
i) inflammation of the ear canal (swimmers ear) - caused by infection (with staph aureus or pseudomonas aeuringosa), seborrhoeic dermatitis, contact dermatitis. recent swimming is a common trigger
ii) ear pain, itch and discharge
otoscopy - red, swollen or eczematous canal
iii) first line - topical abx or abx + steroid
dont given aminoglycosides if TM is perforated
iv) second line - oral abx eg fluclox if it is spreading, swab inside ear canal, anti fungal
if not improving - refer to ENT
MALIGNANT OTITIS EXTERNA
i) what is it? what is the causative organism?
ii) who does it most commonly affect?
iii) which tx may be required?
i) extension of infection in the bony ear canal and soft tissue deep in the ear canal
causative = psuedomonas aeringosaa
ii) most commonly affects elderly diabetics
iii) may need IV abx
GLUE EAR
i) what is it? who is it common in?
ii) name five risk factors
iii) at what age is peak onset? what is the most common presenting feature? name three secondary problems that may occur
iv) name two treatment options
i) otitis media with an effusion and is common in children
ii) male sex, siblings with glue ear, seasonal (winter and spring), bottle feeding, day care attendance, parental smoking
iii) peak age of onset is 2 years
hearing loss is most common px feature
secondary problems - speech/language delay, behavioural problems, balance problems
iv) tx with grommet insertion (to allow air to pass through the middle ear), adenoidectomy
MASTOIDITIS
i) when does it develop?
ii) name five symptoms? is the patient generally unwell? what may be seen if the ear drum has perforated?
iii) how is a dx made? what imaging is done if complications are suspected?
iv) what is the mainstay of tx?
v) name two complications
i) when infection spreads from middle ear into air spaces in the temporal bone (can often start with acute otitis media)
ii) severe behind ear pain, fever, swelling/erythema over mastoid process, ext ear may protrude forward
if ear drum has perforated - ear discharge
ii) clinical dx but may do CT scaan
iv) mainstay tx is IV abx
v) facial nerve palsy, hearing loss, meningitis
EAR WAX
i) name three types of drops that can be given to relieve excess ear wax
olive oil, sodium bicarbonate 5% and almond oil
