Otitis Flashcards
Why can acute otitis media occur after an upper respiratory infection
The infection can extend up the Eustachian tube to the middle ear
Acute otitis media main symptom
Earache
Acute otitis media aetiology
Usually viral infection with secondary bacterial infection
What three bacteria are most commonly associated with acute otitis media
H influenza, strep pneumoniae, strep pyogenes
Acute otitis media
Clinical diagnosis
Unless ear drum has perforated - swab the pus
Acute otitis media treatment
usually self limiting or consider amoxicillin if young patient, both ears affected, lasting longer than 4 days, systemically unwell or perforated ear drum
Otitis externa definition
Inflammation of the outer ear
Otitis externa clinical presentation
Redness & swelling
Itchy or sore
Possible discharge or ear wax
if canal blocked => hearing loss
What are the most common bacterial causes of otitis externa
Staph aureus
proteus species
Pseudomonas aeuruginose
What are the most common fungal causes of otitis externa
- Aspergillus niger
- Candida albicans
What are 3 common triggers of otitis externa
- Water exposure
- Cotton buds
- Skin conditions
Otitis externa treatment
1) Topical aural toilet i.e. clean the ear
2) Swab & send to microbiology
3a) If severe & fungal - Clotrimazole cream
3b) If severe & bacterial - Gentamicin drops
3c) If mild-moderate - supportive care
3d) If eczematous otitis externa - steroids alone
What is malignant (necrotising) otitis externa
It is a rare complication of otitis externa & is an invasive infection of the bone surrounding the ear canal (i.e. the mastoid and temporal bones)
What is the most common cause of malignant otitis externa
Pseudomonas aeruginosa
What are two risk factors for malignant otitis externa
diabetes and radiotherapy to the head and neck
What would make you think of malignant otitis externa
- Pain and headache, more severe than clinical signs
- Granulation tissue at bone-cartilage junction of ear canal
- Exposed bone in the ear canal
- Facial nerve palsy
Malignant otitis externa diagnosis
PV & CRP (inflammatory markers)
Imaging
Biopsy & culture
Malignant otitis externa treatment
Fatal without treatment!
- Correction of immunosuppression where possible
- Local treatment of the auditory canal
(e.g. cleaning and debridement, topical antibiotics) - Long-term systemic antibiotic therapy
- Surgery in selected patients
