Otic disorders

Question 1

What are some symptoms of ear dermatitis?

Answer 1

itchy, dry, red, inflamed skin

Question 2

What are some symptoms of ear foreign body?

Answer 2

inflammation, smelly discharge, painful

Question 3

What are some symptoms of wax impaction?

Answer 3

Ear discomfort, dizziness, reduced hearing, itchy

Question 4

What are some symptoms of acute diffuse otitis externa?

Answer 4

Inflammation of ear canal (w/ or w/out infection)

Question 5

Discuss the treatment for acute localised otitis externa

Answer 5

Systemic antibiotics = usually curative, sometimes surgery necessary

Di/flucloxacillin, 5 days

Penicillin allergy = cephalexin, clindamycin –> for 5 days

Question 6

What should be avoided if ototoxicity is present?

Answer 6

Aminoglycosides –> framycetin, neomycin

Hydrocortisone/ciprofloxacin

Cerumenolytics

Ear drop analgesics

Question 7

What is safe to use if ototoxicity is present?

Answer 7

Ciprofloxacin alone

Chloramphenicol

Cliquinol/flumethasone

Acetic acid = use with caution

Question 8

What are some preventative strategies for otitis externa?

Answer 8

Turn head to drain water, specific alcohol-based ear drops to dry water, acetic acid products (NOT IN PERFORATED EAR DRUM)

moldable silicone ear plugs/rubber ear inserts

Question 9

What are symptoms of middle ear infection?

Answer 9

Fever (38.5+ degree)

Pain in ear

Often after a cold

hearing loss

Question 10

How is otitis media treated?

Answer 10

No systemic symptoms = self limiting (1-3 days)

Ear drop analgesics –> minimal benefit over oral products

Children >2yo = symptoms persist after 2 days then re-evaluate

Question 11

What is the treatment for children 6months - 2 yrs with no systemic symptoms of otitis media?

Answer 11

Symptomatic treatment, re-evaluate after 24hrs

consider antibiotic use beyond 24hrs

Question 12

What is the treatment for children with systemic symptoms of otitis media?

Answer 12

Amoxycillin for 5 days

Poor response = amoxycillin + clavulanic acid 5-7 days

Question 13

For what population group is antibiotic use indicated for treatment of otitis media?

Answer 13

Aboriginal and torres strait islanders

immunocompromised, children <6 months

Question 14

Generally, what is the treatment for Glue Ear?

Answer 14

Glue ear = otitis media –> sticky fluid build up
Antibiotics = 10-30 days OR

minor operation = insert grommets –> allow fluid to drain

Question 15

What is meniere’s disease?

Answer 15

Inc pressure of fluid in labyrinth = attacks of vertigo inc in freq and severity

Symptoms - N/V, tinnitus, perception of deafness

REFER

Treatment = prochorperazine or antihistamine = acute attack, Betahistine = long term balance control

Question 16

How to assess severity of ear conditions

Answer 16

Sever pain? Symptom duration?

Acute otitis media –> check age and symptoms

Glue ear = persist for wks-months

Onset –> lifestyle activities

Common cold, URTI, swimming, diving, air travel

Question 17

When should you refer for ear conditions?

Answer 17

Sign of infection = fever, N/V
Infant under 6 months

Severe pain/earache, itching, discharge in ear canal

hearing loss, Hx/suspicion of ear drum perforation, vertigo, tinnitus, balance problems

persistent ear wax after treatment, foreign body, profuse bleeding/bruising of pinna

Question 18

What are some corticosteroid ear drops (+antifungal, +antibact) for otitis externa (S4)?

Answer 18

Dexamethasone/famycetin/gramicidin

Flumethasone w/ clioqunol

Ciprofloxacin/hydrocortisone

Triamcinolone/neomycin/nystatin/gramicidin