External and Middle Ear - Exam 4 Flashcards
What is the medical term for “swimmers ear”? What organism is MC?
Acute otitis externa (AOE)- diffuse
pseudomonas- MC
_____ is infection of a hair follicle. What organism is MC?
furunculosis
Staph Aureus
_____ is infection of the external ear with a fungal species
otomycosis
Chronic otitis externa
Healthy ear canal skin has an ____ pH. What is the job of the cerumen?
acidic
Serves as a water-repellent coating for the skin of the canal and provides antimicrobial properties
Itching
Severe pain
Conductive hearing loss
Feeling of fullness or pressure
Purulent discharge
Pain with palpation of tragus or traction of auricle (classic sign)
Swollen, red canal
Moist debris in canal
TM difficult to visualize
What am I?
What is the highlighted sign?
What is the tx?
Acute Otitis Externa - Diffuse
Pain with palpation of tragus or traction of auricle (classic sign)
tx:
-clean ear canal to remove debris
-**topical abx: ofloxacin, cipro, neomycin, Polymyxin B
- pain relief
-ear wick
What is an ear wick? When is it used?
drop a few abx drops onto wick and place in ear. Helps distribute medicine and keep medicine in canal
Expands as its moistened
Acute Otitis Externa - Diffuse
Severe diffuse acute otitis externa is commonly seen in what pt population? **What is the tx?
Immunocompromised, elderly, DM
Cipro 500mg BID for 1 week only for severe cases/ immunocompromised
Acute Otitis Externa - Furunculosis is commonly found in the ____ of the canal. What is is caused by? What organism? What is the tx?
Usually lateral ⅓ of canal
Infection of hair follicle
Staph aureus
tx: **Oral Dicloxacillin or Cephalexin (Keflex)
I&D if needed
Chronic Otitis Externa - Otomycosis is a ____ infection of the ear canal. What are the 2 MC organisms?
fungal infection
Aspergillosis and Candidiasis
Ear itching: deep seated itching
discomfort
discharge
foreign body sensation in ear
less severe edema
May resemble mold growing on spoiled food
soft, white, sebaceous-like material that may fill ear canal
What am I?
What is the highlighted symptom?
what is the tx?
Otomycosis
deep seated itching
tx:
-clean canal
-Cotrimazole 1% solution BID 10-14 days
Seborrheic Dermatitis
Psoriasis
Contact Dermatitis
Canal is red, scaly and dry
What am I?
what is the tx?
Chronic Otitis Externa - Non-infective
Topical Hydrocortisone cream/otic drops
Potentially life-threatening
Infections spreads from skin to bone and marrow spaces of the skull base
Elderly patients with Diabetes Mellitus
Immunocompromised patients
severe, deep seated otalgia out of proportion to exam findings
progressive
purulent otorrhea, very foul-smelling
temporal HA
Granulation tissue at the bony cartilaginous junction of the ear canal floor
What am I?
What is the MC organism?
What are the 2 highlighted s/s?
Chronic Otitis Externa - Malignant/Necrotizing
Pseudomonas M/C
Severe, deep seated otalgia out of proportion to examination findings
Granulation tissue at the bony cartilaginous junction of the ear canal floor
What are complications of Chronic Otitis Externa - Malignant/Necrotizing? What is the highlighted one?
Spread to base of skull - osteomyelitis
Spread to meninges and brain
CN involvement - cranial nerve palsy
Thrombosis of sigmoid sinus
High mortality rate
How do you dx Chronic Otitis Externa - Malignant/Necrotizing? what is the tx? How long do you need to continue tx?
CT: to determine the extent of dz
tx: IV and oral abx
1st line: IV Ciprofloxacin 200-400mg BID, tx until clinical improvement then can change to oral cipro 500-1000mg BID
Treat until gallium (nuclear) scan is clear of inflammation (generally 6-8 weeks)
What is another name for Chronic Otitis Externa - Herpes Zoster Oticus? What does it present like? What is the tx?
Ramsay Hunt Syndrome
Unilateral facial nerve (CN VII) palsy, severe otalgia, vesicular eruption on the face. May have altered taste and tongue lesions. (Cannot close eye)
Prednisone and Famciclovir (Famvir) or Valacyclovir (Valtrex)
Where is cerumen produced?
outer portion of ear canal
Ear pain
Fullness
conductive hearing loss
What am I?
What is the tx?
cerumen impaction
irrigation with water
mechanical removal with ear curette
3% hydrogen peroxide
OTC Debrox
What are CI for cerumen impaction?
Presence or history of perforated TM
Previous pain on irrigation
Previous surgery of the middle ear or mastoidectomy
Uncooperative patient
Very hard cerumen
What are some foreign body removal techniques for the ear?
irrigation : avoid if object could expand when wet
alligator forceps
if its an insect need to immobilize with lidocaine first
What is an auricle hematoma? What is a result from? ____ will result if left untreated?
Collection of blood under the perichondria
Results from direct trauma to the anterior auricle
“Cauliflower ear” or “Wrestler’s Ear” as a result of untreated
What is the tx for auricle hematoma?
needs to be within 7 days
Lidocaine 1%: auricle block
I&D
Irrigate pocket with NS
Compression dressing
Leave on for 7 days
Re-examine for recurrence every 24 hours for several days
Avoid NSAIDS
Antibiotic prophylaxis +/-
For an auricular laceration, when are abx indicated? Need to also consider giving _____
Contaminated wound
Bite injuries
Signs of inflammation
tetanus vaccine
Auricular Laceration _____ is preferred. Why? What is the technique?
primary closure
Failure to cover exposed cartilage increases risk of infection
Anesthesia
Debridement
Copious Irrigation
Suture
Packing
Xeroform strips into ear crevices
Petrolatum occlusive dressing
Compression dressing
Recheck 24 hours
Sutures out in 4 - 5 days
Describe the correct way to numb an ear?
2 punctures with a needle
1 at the top of the ear, aim down towards the tragus, injection solution as you are pulling out, rotate the needle 45 degrees without pulling out and aim for the auricle. Repeat at the base of the ear lobe
What 3 nerves are you aiming to block when performing a auricular block?
auriculotemproal nerve
lesser occipital nerve
greater auricular nerve
When would you want to refer to plastic surgery for a auricular laceration?
Large skin avulsions (5 mm or >)
Severe crush injuries
Complete or near complete avulsion
Auricular hematoma
Large cartilage defect (> 5 mm)
Wounds that require removal of > 5 mm tissue
Involvement of auditory canal
Tissue devitalization
______ is a swollen, erythematous, hot external ear lobule usually due from a minor trauma, insect bite, or ear piercing. What is the tx? What is the tx for severe?
Auricular Cellulitis
Choose 1:
Cephalexin
Trimethoprim-Sulfamethoxazole (MRSA)
Clindamycin (MRSA)
and
warm compresses
NSAIDs for pain
severe: IV Vanc
if pt is tachycardic, erythema is rapidly progressing, continues to grow even once on oral abx, fever over 100.5