Middle and Outer Ear Conditions Flashcards
- External Ear Conditions
- Otitis Externa
- Otomyxosis
- Contact dermatitis
- Chronic Suppurative otitis media
- Carcinoma of the ear canal
- Psoriasis
- Middle Ear Conditions
- Acute Otitis Media
- Glue ear or Otitis Media with effusion
- Chronic Otitis Media
- Benign
- Serous
- Suppurative
Define Otitis externa
Acute otitis externa (AOE) is a form of cellulitis that involves the skin and subdermis of the external auditory canal, with acute inflammation and variable oedema. It is colloquially called swimmer’s ear.
Otitis externa Epidemiology
AOE has a lifetime incidence of 10%, with a yearly incidence of 0.4%. The peak age group is at 7 to 12 yo with a decline in those > 50 yo. It is associated with:
- Swimming
- Mechanical ear cleaning
- Devices like head phones or hearing aids.
Otitis externa Pathogenesis
AOE is due to bacterial infection in 90% of cases with Pseudomenas aeruginosa and Staph. aureus the common pathogens.
Otitis externa Clinical Presentation
- Pain - This pain is aggravated by the movement of the auricle (traction of pinna or pressure over tragus).
- Pruritus
- Discharge or otorrhea - Sticky yellow purulent discharge.
- Hearing loss
- Post-articular lymphadenopathy
Otitis externa Investigations
Otoscopy
The canal is edematous and erythematous. There is cerumen (wax) in the canal and a normal tympanic membrane (the mark of solely existing externa).
Otitis externa severity classification
Mild:
- Minimum oedema;
- minor pain
- pruritus.
Moderate:
- Canal partially occluded;
- pain
- pruritus
Severe:
- Occlusion,
- periauricular erythema,
- LN,
- fever;
- intense pain.
Management of Acute diffuse otitis externa
Keep the ear canal as dry
- Don’t syringe with water
- Debris removed by dry aural toilet by a health professional either
- mechanical suction under direct vision
- or dry mopping with cotton wool on a thin carrier (not cotton bud).
This is typically followed by:
- Topical Corticosteroids
— Dexamethasone
- Antibiotic Combination Drops
— Dexamethasone 0.05%
— Framycetin 0.5% (aminoglycaside similar to neomycin)
—
Acute localised is usually a furuncle, folliculitis or a boil, associated with a hair follicle and is commonly due to Staph aureus, systemic antibiotics are usually curative.
Systemic antibiotics Di/flucloxacillin 500mg Gramicidin 0.005% (against gram-positive)
Management of Acute localised otitis externa
Acute localised is usually a furuncle, folliculitis or a boil, associated with a hair follicle and is commonly due to Staph aureus, systemic antibiotics are usually curative.
Systemic antibiotics Di/flucloxacillin 500mg
Management of Recurrent otitis externa
Keeping the ear canals free of water is the mainstay.
- Water exclusion with ear plugs during swimming or showering.
Define Otomyxosis
- A fungal infection that can be a primary infection or secondary to antibiotic therapy for bacterial external otitis.
Signs of external canal contact dermatitis
- Look out for patients with persistent edema and erythema of the external canal and auricle.
Signs of Carcinoma of the ear canal
- A rare disease characterised by mild pain and bloody otorrhea
Define Otitis Media
A spectrum of illness with middle ear fluid and inflammation of the mucosa that lines the middle ear space
Define acute otitis media
- An acute illness with middle ear fluid and inflammation of the mucosa that lines the middle ear space. The infection is often caused by obstruction of the Eustachian tube (Eustachian tube dysfunction), often due to viral URTI. This results in fluid retention and suppuration (formation of pus) of retained secretions.
Define Glue ear or Otitis media with effusion (OME)
- The persistence of middle ear effusion for more than 3 months. Fluid collects in the middle ear space due to negative pressure produced by Eustachian tube dysfunction. The child may have behavioural problems as a result of undetected hearing loss or dull aching otalgia. Over weeks and months, middle ear fluid becomes thick and glue-like causing hearing loss
Define Chronic otitis media (COM)
- An ear with tympanic membrane perforation in the setting of recurrent or chronic ear infections.
- Benign: unassociated with active infection
- Serous: continuous serous (straw-coloured) drainage
- Suppurative: persistent purulent drainage
Epidemiology of otitis media
More than 80% of children experience at least one episode before the age of 2 years with a peak incidence between 6 and 18 months. Children with anatomical abnormalities (cleft palate, cleft uvula) encounter more AOM than their healthy peers.
Otitis media aetiology
A result of
- Viral URTI causing Eustachian tube dysfunction
- Rarer bacterial causes are
- Strep pneumoniae
- Haem influenzae
- Moraxella catarrhalis.
Otitis media Clinical Presentation
- Pain
* Conductive hearing loss
Otitis media Investigations
Otoscopy
- white, bulging tympanic membrane can be seen
- marked erythema along the handle of the malleus
- an air-fluid level in the anterosuperior portion of the tympanic membrane.
Otitis media diagnosis
- A history of acute onset of symptoms and signs
- Demonstrable middle air effusion characterised by:
- Bulging of the tympanic membrane
- Limited or absent movement
- Air-fluid level behind the tympanic membrane
- Perforation with otorrhoea
- Signs and symptoms of middle ear inflammation, characterised by redness of the tympanic membrane
- Demonstrable middle air effusion characterised by:
Otitis media management
- Non-pharmacological - Mainstay of treatment
* Unblock Eustachian tube* Steam * Blowing up balloons * Chewing gum * Analgesia for otalgia * Ibuprofen * Pharmacological * Antibiotics * < 2 years or systemic features * Amoxycillin
Glue ear management
The traditional treatment is ventilation tube (grommet) insertion through the tympanic membrane, which restores hearing in the short term acting as the Eustachian tube. Bacterial infection is only one of many factors that contribute to this condition. Children may benefit from a 10 to 30-day course of amoxycillin.
Indications for referral to an ENT specialist are;
- Effusion for >3 months with educational handicap and/or audiometry showing bilateral hearing loss
- Structural damage to tympanic membrane (significant retraction or cholesteatoma)
Chronic Suppurative Otitis Media management
- Aural toilet is very important.
If aural discharge is from a recent perforation (6 weeks) or persisted >6 weeks
- corticosteroid and antibiotic drops:
- – Dexamethasone + Framycetin + Gramicidin
