Infections and hearing loss Flashcards
Presentation and management of otitis externa
Presents with - chronic itch, recurrent pain, scanty discharge but hearing not affected unless significant swelling. On examination the canal will look red, swollen or eczematous canal.
Swab patients - if repeatedly negative then think cholesteoma
Treat with topical antibiotics +/- with topical steroid (Otomize spray - neomycin, dex and acetic acid). May need to remove debris if lots of it.
Second line - oral antibiotics (flucloxacillin) and empirical use of antifungals. Avoid swimming for 7-10 days.
If using gentamicin drops, must ensure tympanic membrane is intact!!
What the causes of otitis externa
Infection - Bacterial (s.aureus or pseudomonas aeruginosa) or fungal.
Seborrhoeic dermatitis
Contact dermatitis
Recent swimming (if water, think pseudomonas)
Tympanic sclerosis
Calcium deposits in tympanic membrane
What is necrotizing otitis externa and who is at risk?
When the infection spreads and causes osteomyelitis of the temporal bone/base skull/mastoid process.
At risk - diabetes, HIV, immunosuppressed
Presentation and management of necrotizing otitis externa?
Presentation - pain outkeeping with clinical picture, persistent headache, fever. Granulation tissue at junction between bone and cartilage is key finding.
Management -Admission, IV antibiotics for 6-8 weeks and imaging to assess extent of infection
Complications of necrotizing otitis externa?
Facial nerve damage and palsy,
Other CN damage,
Meningitis
Intracranial thrombosis and abscess.
Death
What is ototsclerosis?
Condition where there is bone remodelling of the ossicles leading to conductive hearing loss in patients before the age of 40.
Often autosomal dominant but can be aquired.
Presentation, investigations and management of otosclerosis?
Presentation - Age 20-40. Conductive deafness (worse with low-pitch sounds), tinnitus, may have flamingo tinge to tympanic membrane and +ve fam history.
Ix - Audiometry
Management - hearing aid and stapedectomy (replaces stapes with prosthesis)
What are the causes of otitis media?
Often bacterial spread from an URTI. Common causative organisms are: haemophilus influenza, moraxella cattarhalis and S.aureus.
Presentation of otitis media?
Otalgia - some children may tug or pull their ear,
Fever (50% cases),
Hearing loss,
Recent viral URTI symptoms,
Ear discharge if tympanic perf.
On examination - bulging tympanic membrane with loss of light reflex, opacification/erythema or TM, perforation with purulent otorrhoea (child may be happier once it perfs as infection flows out)
Criteria to diagnose otitis media?
- Acute onset of symptoms (eg, otalgia)
- Presence of middle ear effusion (bulging of membrane, otorrhoea, decreased mobility)
- Inflammation of tympanic memvrane
Management of otitis media?
Generally self limiting and doesn’t require treatment however antibiotics should be given if:
1. No improvement after 72 hours,
2. Systemically unwell but not needing admission,
3. Immunocompromised,
4. Children under 2 years with BILATERAL otitis media.
5. Otitis media with perforation and/or discharge in canal/
First line is 5-7 days of Amoxicillin. If pen allergic then give macrolid.
What are the complications of otitis media?
Chronic suppurative otitis media (perforation of tympanic membrane and otorrhoea > 6 weeks),
Hearing loss,
Labyrinthitis,
Mastoiditis,
Meningitis,
Brain abscess,
Facial nerve palsy.
What can cause sensorineural hearing loss?
Sudden sensorineural hearing loss (over less than 72 hours)
Presbycusis (age-related)
Noise exposure
Ménière’s disease
Labyrinthitis
Acoustic neuroma
Neurological conditions (e.g., stroke, multiple sclerosis or brain tumours)
Infections (e.g., meningitis)
Medications - loop diuretics, gentamicin, chemo.
What can cause conductive hearing loss?
Ear wax (or something else blocking the canal)
Infection (e.g., otitis media or otitis externa)
Fluid in the middle ear (effusion)
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours
