Infectious Diseases of the Ear Flashcards
Describe the location affected by each of the following conditions:
otitis externa
otitis media
mastoiditis
- otitis externa: outer ear (ear canal & pina)
- otitis media: middle ear
- mastoiditis: mastoid process
What is pruitis?
itching of the ear
What is otalgia?
ear pain
What is otorrhea?
discharge from the ear
What is tinnitus?
ringing of the ear
What is the most common form of otitis externa?
Etiological causes?
How is it frequently initiated?
Onset?
Swimmer’s ear / benign otitis externa / acute diffuse otitis externa
Pseudomonas & Staphylococcus aureus
seen in swimmers - initiated by moisture
onset ~ 48 hrs
What demographic is most commonly affected by malignant otitis externa?
Etiological agent?
necrotizing otitis externa / invasive otitis externa
immunocompromised, elderly & diabetic
Pseudomonas aeruginosa
What is acute locatlized otitis externa?
Etiological agent?
furunculosis
infection of a hair follicle of the outer ear
Saphylococcus aureus
Waht is the cause of eczematous otitis externa?
various allergic & autoimmune dematologic conditiosn that affect the external ear
What is herpes zoster oticus?
This can lead to what complicaiton?
This can be prevented by what vaccine?
varicella-zoster infection of the face & ear
painful rash of blisters in ear, mouth & throat
Can cause Ramsay Hunt syndrome: muscles of the face paralyzed
Vaccine: VZV & zoster vaccines
What is otomycosis & what are the common etiological causes?
fungal infection of the ear canal, usually caused by Aspergillus or Candida
What is a differentiating factor between otitis externa caused by bacteia & otomycosis?
more intense itching in otomycosis
What are the symptoms of otitis externa?
- itching progressing to otalgia
- edema & erythema of ear canal
- otorrhea
- tenderness of tragus & pinna
- aural fullness
- palpable periauricular & cervicl lymph nodestympanic membrane moves well w/ puff of air
How could you differentiate between otitis externa & otitis media?
kids with otitis externa will not be pulling on their ears
tympanic membrane will move from a puff of air with otitis externa but will not with otitis media
Otorrhea is most common in otitis externa from what etiological agents?
Describe the individual characteristics of the otorrhea.
- Pseudomonas*: purulent otorrhea that may be green or yellow
- Aspergillus*: fine white fuzzy mat topped by black spheres
What can you do to prevent otitis externa?
Keep ear canal clean & dry
after water sports, apply to ear canal 1 part white vinegar, 1 part water, 2 parts rubbing alcohol
What is the treatment for otitis externa?
eardrops w/ acetic acid, antiseptics, antimicrobials & corticosteroids
analgesics
if chronic, also use selenium sulfide to kill mites
What is malignant otitis externa?
Most common etiological causes?
an infection that begins as an external otitis that progresses to osteomyelitis of the temporal bone
Causes: Pseudomonas aeruginosa, Aspergillus
What group of people are particularly susceptible to malignant otitis externa?
elderly diabetics
Complication of malignant otitis externa?
cellulitis & osteomyelitis of surroundign tissue and bone
TMJ involvement (trimus from masseter)
Bell’s palsy
Symptoms of malignant otitis externa?
purulent ear discharge, erythema & edema of ear canal
severe pain our of proportion to ear exam
temporal headache, trimus, dysphagia, hoarseness
granulation tissue in external auditory canal
Bell’s palsy
What is the typical fever & WBC in malignant otitis externa?
How is a diagnosis made?
usually not fever & WBC is usually normal
biopsy granulation tissue for culture & antimicrobial sensitivity
bone scanning, CT & MRI
Treatment for malignant otitis externa?
antibiotics
aggressive glycemic control
surgery
hyperbaric oxygen
What is acute otitis media?
inflammatory disease of hte middle ear
abrupt onset & is associated iwth one or more systemic signs of disease ie. headache, fever, vomiting, or diarrhea
What is otitis media with effusion?
(serous otitis media)
inflammatory disease of the middle ear
clear fluid in the middle ear for extended period but w/o ear pain or systemic signs of infection
tinnitus, vertigo & hearing loss are common
often follows acute otitis media
Why is it important to distinguish acute otitis media with otitis media with effusion?
otitis media with effusion does not respond to antibiotic treatment
What is chronic suppurative otitis media?
inflammatory disease of the middle ear
persists for 6 weeks+ & purulent otorrhea, tympanic membrane perforation, some hearing lost & often a cholesteatoma
What is a cholesteatoma?
mass of keratinaceous debris
What is adhesive otitis media?
inflammatory disease of the middle ear
occurs when the retracted tympanic membrane becomes aspirated into the middle ear space & gets stuck there
What is the definitio of recurrent otitis media?
greater than or equal to 3 episodes of acute otitis media within 6 months,
or
4 or more episodes within 12 months
Symptoms of otitis media?
abrupt-onset otorrhea w/ purulent white to yellow discharge
otalgia, aural fullness, tinnitus
headache
infancy: fever, ear tugging, irritability, vomiting, diarrhea, anorexia
What are the exam findings of the tympanic membrane?
middle-ear effusion
opacity
bulging
erythema
decreased mobility with pneumatic otoscopy
What demographic is most commonly affected by otitis media?
Why?
children
b/c have shorter & more horizontal eustachian tubes
children under 2 cannot generate antibodies to polysaccharide capsules that protect manyof the bacterial etiologies of OM from phagocytosis
What are the most common etiologial causes of otitis media?
- Streptococcus pneumoniae*
- Haemophilus influenzae*
- Moraxella catarrhalis*
Describe the pathophysiology of bacterial otitis media
Viral infection causes the middle ear cavity to thicken, which creates a negative pressure & the formation of a sterile transudate
bacterial from nasopharynx contaminate this fluid, create pus &cause tympanic membrane to bulge as the middle ear cavity fills with fluid
What is the treatment for otitis media?
What are the specific guidlines regarding antibiotic use?
clean ear canal & treat pain and fever with ibuprofen/acetaminophen
- Receive antibiotics
- patients < 6 months
- Children under 2 with bilateral acute otitis media
- anyone with moderate to severe otalgia or otalgia for 48 hrs
- temp over 39 degrees C
- tympanic membrand perforation
- immunocompromised
- uncertain about follow-up
- DO NOT receibe antibiotics
- patients over 6 months with mild to moderate unilateral acute otitis media
- patients 2 years+ with mild to moderate acute otitis media in one or both ears
What is the OMM technique to treat acute otitis media?
Galbreath technique
manipulating mandible to press on pterygoid plexus & lymphatics that mainly drain the middle ear
What is the treatment for recurrent otitis media?
tympanostomy tubes
will eventually fall out & the membrane will heal
Under what conditions would a physician perform a tympanocentesis?
to releive pressure on the eardrum
to determine etiology of an immunocompromised patient / not responding to antibiotics
most appropriate in infants less than 2-3 months
What are the possible complications from otitis media with effusion following a bout of acute otitis media?
How is this treated?
if persists for months can lead ot significnat hearing loss & impaired language skills
typanostomy tubes
How long do most cases of otitis media with effusion last?
Treatment?
usually self-limiting & resolve within 2-4 weeks
What can happen if there is a perforation in the tympanic membrane during chronic suppurative otitis media?
Why is this a problem?
can lead to the formation of a cholesteatoma (mass or keratinaceous debris)
can erode bone & promote infection
lead to meningitis, brain abscess or facial nerve paralysis
What are the most common etiologial causes or chronic suppurative otitis media?
P. aeruginosa, S. aureus, Klebsiella pneumoniae, & Corynebacterium
What is the usual cause of adhesive otitis media?
What are the typical complications?
treatment?
occurs after prolonged period of negative middle ear pressure
complications are retraction pocket & cholesteatoma
treatment: tube or grommett to normalize pressure
What are the vaccines that help to prevent otitis media?
When should each be administerd?
- Streptococcus pneumoniae
- PCV13 & PCV23 - diptheria toxin
- 2 mo., 4 mo., 6 mo., 12-15 mo.
- >65 years
- PCV13 & PCV23 - diptheria toxin
- Hib
- conjugate
- 2 mo., 12-15 mo.
- conjugate
- Influenza
- LAIV (live attenuated)
- 2-49 yrs
- IIV4 (inactivated)
- 6 mo. +
- LAIV (live attenuated)
What is mastoiditis?
inflammation / bacterial infection of mastoid process that results in coalescence of the mastoid air cells
acute – ususally associated with acute otitis media
chronic – usually associated with chronic supparative otitis media
What are the most common etiological causes of mastoiditis?
Acute: S. pneumoniae, H. influenzae, group A streptococci (S. pyogenes)
Chronic: gram negatives (pseudomonas) & S. aureus
Also: Fusobacterium necrophorum, Nocardia asteroides, Aspergillus, Mycobacterium spp.
What are possible complications of mastoiditis?
deep neck or brain abscesses, septic thrombosis of sigmoid or lateral sinus, CNVII involvement
What are the signs & symptoms of mastoiditis?
redness, swelling, tenderness & fluctuation over mastoid process
pinna displaced laterally & inferiorly
exacerbation aural pain, fever & creamy otorrhea
bulging & immobility of tympanic membrane
Diagnosis of mastoiditis?
Leukocytosis & elevated erythrocyte sedimentation rate
CT - abscess-like cavities in mastoid process & indistinct air cell partitions
MRI- intracranial soft tissue involvement
What is the treatment for mastoiditits?
antimicrobial therapy & drainage of middle ear and mastoid cells
possivle mastoidectomy (osteitis, abscess, intracranial involvement, or no improvement 24-48 hrs after antibiotics)
