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S3B1 IDIS > Infectious Diseases of the Ear > Flashcards

Infectious Diseases of the Ear Flashcards

1
Q

Describe the location affected by each of the following conditions:

otitis externa

otitis media

mastoiditis

A
  • otitis externa: outer ear (ear canal & pina)
  • otitis media: middle ear
  • mastoiditis: mastoid process
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2
Q

What is pruitis?

A

itching of the ear

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3
Q

What is otalgia?

A

ear pain

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4
Q

What is otorrhea?

A

discharge from the ear

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5
Q

What is tinnitus?

A

ringing of the ear

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6
Q

What is the most common form of otitis externa?

Etiological causes?

How is it frequently initiated?

Onset?

A

Swimmer’s ear / benign otitis externa / acute diffuse otitis externa

Pseudomonas & Staphylococcus aureus

seen in swimmers - initiated by moisture

onset ~ 48 hrs

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7
Q

What demographic is most commonly affected by malignant otitis externa?

Etiological agent?

A

necrotizing otitis externa / invasive otitis externa

immunocompromised, elderly & diabetic

Pseudomonas aeruginosa

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8
Q

What is acute locatlized otitis externa?

Etiological agent?

A

furunculosis

infection of a hair follicle of the outer ear

Saphylococcus aureus

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9
Q

Waht is the cause of eczematous otitis externa?

A

various allergic & autoimmune dematologic conditiosn that affect the external ear

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10
Q

What is herpes zoster oticus?

This can lead to what complicaiton?

This can be prevented by what vaccine?

A

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

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11
Q

What is otomycosis & what are the common etiological causes?

A

fungal infection of the ear canal, usually caused by Aspergillus or Candida

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12
Q

What is a differentiating factor between otitis externa caused by bacteia & otomycosis?

A

more intense itching in otomycosis

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13
Q

What are the symptoms of otitis externa?

A
  • 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
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14
Q

How could you differentiate between otitis externa & otitis media?

A

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

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15
Q

Otorrhea is most common in otitis externa from what etiological agents?

Describe the individual characteristics of the otorrhea.

A
  • Pseudomonas*: purulent otorrhea that may be green or yellow
  • Aspergillus*: fine white fuzzy mat topped by black spheres
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16
Q

What can you do to prevent otitis externa?

A

Keep ear canal clean & dry

after water sports, apply to ear canal 1 part white vinegar, 1 part water, 2 parts rubbing alcohol

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17
Q

What is the treatment for otitis externa?

A

eardrops w/ acetic acid, antiseptics, antimicrobials & corticosteroids

analgesics

if chronic, also use selenium sulfide to kill mites

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18
Q

What is malignant otitis externa?

Most common etiological causes?

A

an infection that begins as an external otitis that progresses to osteomyelitis of the temporal bone

Causes: Pseudomonas aeruginosa, Aspergillus

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19
Q

What group of people are particularly susceptible to malignant otitis externa?

A

elderly diabetics

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20
Q

Complication of malignant otitis externa?

A

cellulitis & osteomyelitis of surroundign tissue and bone

TMJ involvement (trimus from masseter)

Bell’s palsy

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21
Q

Symptoms of malignant otitis externa?

A

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

22
Q

What is the typical fever & WBC in malignant otitis externa?

How is a diagnosis made?

A

usually not fever & WBC is usually normal

biopsy granulation tissue for culture & antimicrobial sensitivity

bone scanning, CT & MRI

23
Q

Treatment for malignant otitis externa?

A

antibiotics

aggressive glycemic control

surgery

hyperbaric oxygen

24
Q

What is acute otitis media?

A

inflammatory disease of hte middle ear

abrupt onset & is associated iwth one or more systemic signs of disease ie. headache, fever, vomiting, or diarrhea

25
Q

What is otitis media with effusion?

A

(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

26
Q

Why is it important to distinguish acute otitis media with otitis media with effusion?

A

otitis media with effusion does not respond to antibiotic treatment

27
Q

What is chronic suppurative otitis media?

A

inflammatory disease of the middle ear

persists for 6 weeks+ & purulent otorrhea, tympanic membrane perforation, some hearing lost & often a cholesteatoma

28
Q

What is a cholesteatoma?

A

mass of keratinaceous debris

29
Q

What is adhesive otitis media?

A

inflammatory disease of the middle ear

occurs when the retracted tympanic membrane becomes aspirated into the middle ear space & gets stuck there

30
Q

What is the definitio of recurrent otitis media?

A

greater than or equal to 3 episodes of acute otitis media within 6 months,

or

4 or more episodes within 12 months

31
Q

Symptoms of otitis media?

A

abrupt-onset otorrhea w/ purulent white to yellow discharge

otalgia, aural fullness, tinnitus

headache

infancy: fever, ear tugging, irritability, vomiting, diarrhea, anorexia

32
Q

What are the exam findings of the tympanic membrane?

A

middle-ear effusion

opacity

bulging

erythema

decreased mobility with pneumatic otoscopy

33
Q

What demographic is most commonly affected by otitis media?

Why?

A

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

34
Q

What are the most common etiologial causes of otitis media?

A
  • Streptococcus pneumoniae*
  • Haemophilus influenzae*
  • Moraxella catarrhalis*
35
Q

Describe the pathophysiology of bacterial otitis media

A

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

36
Q

What is the treatment for otitis media?

What are the specific guidlines regarding antibiotic use?

A

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
37
Q

What is the OMM technique to treat acute otitis media?

A

Galbreath technique

manipulating mandible to press on pterygoid plexus & lymphatics that mainly drain the middle ear

38
Q

What is the treatment for recurrent otitis media?

A

tympanostomy tubes

will eventually fall out & the membrane will heal

39
Q

Under what conditions would a physician perform a tympanocentesis?

A

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

40
Q

What are the possible complications from otitis media with effusion following a bout of acute otitis media?

How is this treated?

A

if persists for months can lead ot significnat hearing loss & impaired language skills

typanostomy tubes

41
Q

How long do most cases of otitis media with effusion last?

Treatment?

A

usually self-limiting & resolve within 2-4 weeks

42
Q

What can happen if there is a perforation in the tympanic membrane during chronic suppurative otitis media?

Why is this a problem?

A

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

43
Q

What are the most common etiologial causes or chronic suppurative otitis media?

A

P. aeruginosa, S. aureus, Klebsiella pneumoniae, & Corynebacterium

44
Q

What is the usual cause of adhesive otitis media?

What are the typical complications?

treatment?

A

occurs after prolonged period of negative middle ear pressure

complications are retraction pocket & cholesteatoma

treatment: tube or grommett to normalize pressure

45
Q

What are the vaccines that help to prevent otitis media?

When should each be administerd?

A
  • Streptococcus pneumoniae
    • PCV13 & PCV23 - diptheria toxin
      • 2 mo., 4 mo., 6 mo., 12-15 mo.
      • >65 years
  • Hib
    • conjugate
      • 2 mo., 12-15 mo.
  • Influenza
    • LAIV (live attenuated)
      • 2-49 yrs
    • IIV4 (inactivated)
      • 6 mo. +
46
Q

What is mastoiditis?

A

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

47
Q

What are the most common etiological causes of mastoiditis?

A

Acute: S. pneumoniae, H. influenzae, group A streptococci (S. pyogenes)

Chronic: gram negatives (pseudomonas) & S. aureus

Also: Fusobacterium necrophorum, Nocardia asteroides, Aspergillus, Mycobacterium spp.

48
Q

What are possible complications of mastoiditis?

A

deep neck or brain abscesses, septic thrombosis of sigmoid or lateral sinus, CNVII involvement

49
Q

What are the signs & symptoms of mastoiditis?

A

redness, swelling, tenderness & fluctuation over mastoid process

pinna displaced laterally & inferiorly

exacerbation aural pain, fever & creamy otorrhea

bulging & immobility of tympanic membrane

50
Q

Diagnosis of mastoiditis?

A

Leukocytosis & elevated erythrocyte sedimentation rate

CT - abscess-like cavities in mastoid process & indistinct air cell partitions

MRI- intracranial soft tissue involvement

51
Q

What is the treatment for mastoiditits?

A

antimicrobial therapy & drainage of middle ear and mastoid cells

possivle mastoidectomy (osteitis, abscess, intracranial involvement, or no improvement 24-48 hrs after antibiotics)

S3B1 IDIS (2 decks)

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