ENT Flashcards
What is otitis externa?
inflammation of the skin of the ear canal
usually due to bacterial infection
Common causes of otitis externa?
pseudomonas (from swimming) and staph A
Presentation of otitis externa?
redness and swelling of skin of ear canal
itchy progressing to sore and painful
discharge and/ or increased amounts of wax
if canal becomes blocked by swelling or secretions hearing can be affected
Treatment of otitis externa?
mild: acetic acid (ear calm) drops
moderate or severe: topical gentamicin combined with steroid drops
for fungal infections give clotrimazole
What is otitis media?
inflammation of the middle ear which is extremely common in children
What type of organism usually causes otitis media?
often viral with secondary bacterial infection e.g. strep pneumo, strep pyogenes or HiB
Where does the infection come from in otitis media?
usually comes from the nose or pharynx via the eustachian tube which in children is shorter, wider and more horizontal so infection can track upwards more easily
Presentation of otitis media?
a cold, then temperature and then pain in the ear
fever
loss of hearing is followed by otorrhoea which is discharge from the ear due to rupture of tympanic membrane which relieves the pain
What may you see with otitis media on otoscopy?
bulging tympanic membrane
Management of otitis media?
treatment of acute case is initially with NSAIDs
it is usually viral in origin so will settle in 72 hrs without antibiotics
consider antibiotics if less than 2yo and bilateral or bulging membrane or systemic symptoms or ottorrhoea or not clearing
1st line is amoxicillin
2nd line is clarithromycin
Main type of organism causing tonsillitis?
mainly due to viral infection
majority of cases - EBV, rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
What type of tonsillar disease is more likely to be bacterial and what organisms are involved?
chronic tonsillar disease
strep pyogenes, H influenza, S aureus and strep pneumonia
What type of tonsillitis is it important to rule out and why?
GABHS (group a beta haemolytic strep - basically strep pyogenes) because it can cause rheumatic fever and glomerulonephritis
Compare presentation of viral vs bacterial tonsillitis?
VIRAL: malaise, sore throat, temperature, possible lymphadenopathy but able to undertake normal activites, lasts 3-4 days, cough
BACTERIAL: systemic upset, fever, odynophagia, halitosis, lymphadenopathy, unable to work, lasts 1 week, absence of cough, presence of exudates
What guidelines are used to assess probability of tonsillitis being bacterial?
centor
