Otalgia Flashcards
name 5 causes of ear pain
- acute otitis externa
- malignant otitis externa
- acute mastoiditis
- acute suppurative otitis media
- otitis media with effusion
name 5 causes of otorrhoea/discharge
- acute suppurative otitis media
- chronic suppurative otitis media
- chronic otitis externa
- CSF following head injury
- acute coalescent mastoiditis
3 types of Otitis externa
- acute
- chronic
- malignant
Acute otitis externa is …
diffuse inflammation of the external ear canal, which may also involve the pinna + tympanic membrane
Presentation of AOE
- otalgia
- pain on moving the pinna
- otorrhoea
- conductive hearing loss
- itchy
Patient with AOE may have a history of ____
swimming
ear canal in acute AOE is …
oedematous + tender
potential causes of AOE?
- previous ear surgery
- topical treatments
- trauma to ear canal (e.g. from cleaning)
- use of hearing aids/ear plugs
- exposure to warm climate
condition that is a risk factor for AOE?
diabetes mellitus + immunosuppression
how is AEO diagnosed?
Presence fo symptoms of rapid onset (within 24 hours) within past 3 weeks
+
signs of ear canal inflammation
usual organism for AOE (2)
- Pseudomonas Aeruginosa
- Staphylococcus Aureus
management of AOE?
topical abx w/ or w/o/ steroids
minimum of 7 days
what abx should you not give if there is tympanic membrane perforation, and why?
Aminoglycosides
risk of ototoxicty
3 complications of AOE?
- facial cellulitis
- otomycosis
- malignant otitis externa
what is Otomycosis and what causes it?
fungal ear infection, of the external auditory canal
well known complication of long term treatment with antibacterial agents
Late complication of Otomycosis
Canal stenosis with hearing loss
what is the risk of diabetics + immunocompromised individuals with Malignant otitis externa?
They are assumed to have osteomyelitis of the temporal bone if symptoms do not settle within 2 weeks
who is at risk of Malignant otitis externa
Diabetes or immunosuppressed
where does the infection begin and progress to in malignant otitis externa?
begins in the soft tissue of the external auditory meatus –> progresses to into the bony ear canal, can progress to temporal bone osteomyelitis
CT findings in Malignant otitis Externa
Soft tissue + bone destruction, granulation tissue in the ear canal
clinical features in Malignant Otitis Externa
- otalgia
- purulent otorrhoea
- aural fullness
- not responding to conventional treatment for AOE
what can malignant otitis externa cause by affecting the middle ear
sensorineural hearing loss
management of Malignant otitis externa
IV Gentamicin or Ciprofloxacin
most common causative organism in Malignant otitis externa
Pseudomonas Aeruginosa
Chronic otitis Externa is caused by…
chronic combined infection of fungal + staphylococcal
clinical features of COE
chronic discharge accompanied by itching + irritation
describe the discharge in COE
chronic, thick, smelly
signs of fungal infection in COE?
- white cotton like strands of candida
OR - small black/white balls of Aspergillus
symptoms in COE? (3)
- hearing loss
- discharge
- itching
cause of COE?
- skin disease: eczema, psoriasis
- external trauma to the ear: wetting, drying, scratching
Management of COE?
- cleanse external ear
- antibacterial + antifungal ear drops
- cleaning: remove infected debris
- aural toilet: cleaning external auditory meatus
- microbial swabs for bacteria + fungus
