ENT: Otalgia Flashcards
What proportion of otalgia is due to referred pain?
Approx. 50%
What makes up the outer ear?
Pinna
Ear canal
Ear drum
What makes up the middle ear?
Oscicles
Unlikely to have an abnormal middle ear with normal drum
What makes up the inner ear?
Vestibulocochlear apparatus
Insensive
What are the otological (non referred) causes of ear pain?
Acute otitis media
Otitis externa
Furuncule
Necrotising otitis externa
What are the refered causes of otological pain?
Dental pathology TMJ (temperomandibular joint) dysfunction Osteoarthritis of the cervical spine Malignancy of pharynx and larynx Acute infection of pharynx
When would you consider refered pain?
In presence of normal ear exam.
What are red flags for oropharyngeal malignancy with otalgia?
Dysphagia
Hoarseness
Dysphonia
What is otitis externa?
Infection of the outer ear (aka Swimmer’s ear)
What are the symptoms of otitis externa?
Painful discharging ear
What are the risk factors of otitis externa?
Eczema/dermatitis
What are the common causative organisms of otitis externa?
Pseudomonas
Fungal infection
How is otitis externa diagnosed?
Ear examination
Debris in ear
Oedema or stenosis of ear canal
What differs in fungal otitis externa?
Visible fungus or black debris in ear.
What is the treatment of bacterial otitis externa?
Topical antibiotics (1st line)
Gentamycin/Ciprofloxacin
Oral is less recommended, won’t reach the debris.
Microsuction
Insertion of pope wick
Water precautions
What is the treatment of fungal otitis externa?
Clotrimazole 1% topical for at least 14 days.
How can you prevent otitis externa?
Keep ears dry - pool guards
Don’t use ear buds
Acetic acid
What is a furuncle?
Staphylococcal abcess on a hair follicle.
What are the symptoms of a furuncle?
Exquisitely tender
Dry ear - not otitis externa
What is the treatment of a furuncle?
Incision and drainage
Flucloxacillin
Wick insertion
What is necrotising (malignant) otitis externa?
Potentially fatal osteomyelitis of the EAM and bony tympanic plate.
How can necrotising (malignant) otitis externa be fatal?
Can spread along the inferior surface of the skull base, complications include meningitis, cerebral abscess and dural sinus thrombosis.
Who is more at risk of necrotising (malignant) otitis externa?
Elderly diabetic patients
What is the typical causative organism of necrotising (malignant) otitis externa?
Psudomonas aeruginosa
What is the presentation of necrotising (malignant) otitis externa?
Severe, unremitting otalgia
Purulent aural discharge
Granulations at the isthmus (bone-cartilage junction) of EAM.
Single or multiple cranial neuropathies may also occur, usually VII.
What is acute otitis media?
Infection of the middle ear
Who does acute otitis media occur in?
Mainly children
What are the common causative organisms of acute otitis media?
RSV
Rhinovirus
Parainfluence
Streptococcus pneumonie
Haemophillus influenxe
Moracella catarrhailis
What are the signs and symptoms of acute otitis media?
Inflammation of the middle ear
Bulging tympanic membrane
Rapid onset ear ache
Rubbing and tugging of the ear
Systemic signs: fever, irritability, poor sleep
Preceding URTI symptoms: cough, rhinorrhea.
What is the treatment of acute otitis media?
Largely self limiting
Usually viral resolving in 48-72 hours.
Antibiotics if: Increasingly unwell Decreased PO intake Increasing pain No improvement in 72 hours Developing complications
Role for delayed Abx presentation (5 day course)
What is the treatment for recurrent acute otitis media?
Grommet insertion
What are the complications of acute otitis media?
Mastoiditis Tympanic membrane perforation (chronic) Rare: Meningitis Abscesses Nerve palsy Hearing loss
