Otalgia Flashcards
What are symptoms of otitis eternal?
Discharge, itch, ear pain, tragal tenderness
Inflammation of the skin of the meatus, usually caused by excess canal moisture
What are causes of otitis external?
Infection Trauma - fingernails Excess canal moisture High humidity Absence of wax Narrow ear canal Hearing aids Seborrheic dermatitis Contact dermatitis - allergic and irritant
What is the chief organism causing OE?
Pseudomonas aeruginosa
Also Staphylococcus aureus
Describe mild vs moderate OE vs severe OE
Mild: scaly skin with some erythema, normal diameter of the EAC
Moderate: painful ear, narrowed EAC, with malodorous creamy discharge
Severe - EAC is occluded
What in management for mild OE?
Cleaning the EAC is key
Ears should be kept water free during treatment
In mild, use hydrocortisone cream to the pinna and acetic acid which acts as antifungal/antibacterial
What is management for moderate OE?
Swab for microscopy
Clean the EAC
Precribe topical antibiotic±steroid drops
Topical aminoglycosides are CI in patients with a perforated TM or patent grommet due to theoretical risk of ototoxicity.
Otosporin
If there is canal debris, consider removal.
Use drops for < 7 days
What is management for severe OR?
Thin ear wick can be inserted e.g. aluminium acetate
After a few days the meatus will open up enough for either micro suction or careful cleansing
What is the risk of persistent unilateral OE in diabetics/immunosuppressed?
Malignant/necrotising otitis externa
What is furunculosis?
Painful staphylococcal abscess arising in a hair follicle within the canal.
Consider lancing
If there is pinna cellulitis start oral abx (flucloxacillin)
What is malignant/necrotising otitis externalities? What is the common cause? What is treatment?
Aggressive, life threatening infection of the external ear that can lead to temporal bone destruction and base of skull osteomyelitis
Severe otaliga, temporal headache, purulent otorrhea
Usually caused by pseudomonas aeruginosa, also Proteus and Klebsiella
Treated by surgical debridement, systemic IV abx, specific immunoglobulins
What is Barotrauma? Symptoms? Management? Prevention?
If the Eustachian tube is occluded, middle ear pressure cannot be equalised during descent in an aircraft or diving, thus causing damange
Severe pain as drum becomes indrawn initially then a secondary effusion may occur as a transudate or haemotympanum
Management: supportive
Prevention: Not flying with an URTI, decongestants into the nose
What are symptoms/signs of TMJ dysfunction?
Earache, facial pain, joint clicking, joint derangement, stress
Joint tenderness, exacerbated by lateral movement of the open jaw
Most patients improve without treatment. Simple analgesia
How can the EAC be cleaned?
Gentle syringe or irrigation to remove debris
Dry mopping: under direct vision using probe, corona wool on end, clean EAC with rotary action
Microsunction: refer to ENT
Where can refer pain to the ears?
Trigeminal nerve may refer pain from dental disease and TMJ dysfunction to the lateral upper half of pinna
Sensory branch of facial nerve supplies lateral surface of ear drum refers pain in geniculate herpes - Ramsay hunt
Primary glossopharyngeal neuralgia can cause pain induced by talking or swallowing.
Typical branch of IX and auricular branch of X (supplies medial surface of drum) can refer pain from posterior 1/3 of tongue, larynx
