Otitis Externa

Question 1

What 3 tissues is the auricle (pinna) earlobe made of?

Answer 1

1. cartilage
2. perichondrium
3. thin vascularized skin

Question 2

What are the two sections is the external auditory meatus/ear?

Answer 2

1. outer: hair, sebaceous and ceruminous glands

2. inner: rigid bone

Question 3

What is the Isthmus?

Answer 3

narrowing of the canal

Question 4

What are 3 characteristics of cerumen?

Answer 4

1. acidic pH: protects against infection
2. hydrophobic: protects skin of external ear canal from water damage
3. self-cleaning: epidermal cells migrate to outside by jaw movement

Question 5

What are signs of impacted cerumen?

Answer 5

fullness, 
hearing loss,
tinnitus
itchiness 
NO PAIN

Question 6

Risk factors for impacted cerumen?

Answer 6

anatomy of the ear
overproduction of cerumen 
migration failure 
foreign objects in the ear 
prior history of impaction 
older age

Question 7

How to treat impacted cerumen?

Answer 7

only for symptomatic pts

Cerumenolytics

• oil based wax softeners (olive oil, light mineral oil, almond hair) used 4days per week for 2-3 weeks
• water based wax softeners (water, saline, hydrogen peroxide)

Professional removal

• irrigation
• manual removal

Question 8

When to refer patient when they have impacted cerumen?

Answer 8

rash in-ear or ear infection
history of ear surgery or tubes in the ear
foreign object in the ear

the suspected burst eardrum
(bleeding/discharge, dizziness, pain, ringing sound, hearing loss)

Question 9

What is otitis externa known as?

Answer 9

“Swimmers ear”

Question 10

inflammation of the external ear canal

Answer 10

otitis externa

Question 11

What is considered acute OE

what is considered chronic OE

Answer 11

acute < 3 weeks

chronic > 3 weeks

Question 12

What bacteria causes acute OE

Answer 12

Pseudomonas
S. aureus
klebsiella, proteus

Question 13

what organism causes chronic chronic OE?

Answer 13

caused by fungi or allergies
otomycosis
aspergillus
candida albicans

Question 14

List some risk factors for otitis externa

Answer 14

long time in the water  and pH goes up 
high temperature 
no ear wax
trauma
using foreign objects 
dermatology conditions 
age (7-12)

Question 15

Symptoms of otitis externa

Answer 15

pain *within 48 hours) 
itching 
ear fullness
headache 
discharge 
swollen ear canal 
loss of hearing

Question 16

When diagnosing otitis externa, what four things can you rule out?

Answer 16

acute otitis media
malignant otitis externa
dermatological conditions of the ear
sensitization from otic medications

Question 17

When to refer to physician for otitis externa?

Answer 17

fever, malaise,
bleeding/discharge
progressing ear pain, stabbing pain, hearing loss

Question 18

Goals of therapy

Answer 18

eliminate pathogen organisms
control/relieve pain and otorrhea
restore ear canal to normal health, normal pH and adequate cerumen

Question 19

Non pharm treatment options for patient with otitis externa

Answer 19

keep the ear dry and avoid water in the ear for 7-10 days
clean ear canal
analgesic treatment

Question 20

Pharmacolgical treatment for otitis externa

Answer 20

1. acidifying agents
2. topical antibiotics

Systemic therapy only for severe cases

Question 21

What is the function of acidifying agents in otitis externa?

Answer 21

produce low pH
use vinegar: water
dilute it 50% with water and can be used as prophylaxis

Question 22

List some antibacterial OTC agents

Answer 22

polysporin

polysporin + pain relief

Question 23

Antibacterial agents Rx

Answer 23

fluoroquinolones
aminoglycosides
combinations (ciprodex)

Question 24

List 5 drug families that are known to cause ototoxicity

Answer 24

aminoglycosides 
other antibiotics (erythromycin, tetracycline)

Usually reversible but cause ototoxicty
chemotherapeutic agents
salicylates
antimalarials

Question 25

Is fungus more common in acute OE or chronic OE ?

Answer 25

chronic OE

Question 26

Signs and symptoms for fungal otitis externa?

Answer 26

itching, slight pain
black fine exudate
white brown film

Question 27

Treatment for fungal otitis externa

Answer 27

ear cleaning + topical therapy
acetic acid
antifungal

Question 28

Signs of otitis externa caused by herpes simplex, zoster or measles

Answer 28

pain, blister swelling

Question 29

an infection in the ear that spreads to the cartilage and temporal bone

Answer 29

otitis externa - malignant

Question 30

what can otitis externa malignant lead to?

a) osteoporosis
b) osteoarthritis
c) osteomyelitis
d) osteoblast

Answer 30

c) osteomyelitis

Question 31

How long should otitis externa be monitored?

Answer 31

improvement within 24 hours

monitor for 48-72 hours for improvement

Question 32

how long is duration of therapy with topical therapy?

Answer 32

7-10 days

Question 33

how is the systemic delivery of drugs to the inner ear limited?

Answer 33

blood labyrinth barrier

high systemic concentrations needed

Question 34

What are the two types of otic drug delivery?

Answer 34

solution/suspensions

ointments

Question 35

what two ingredients are used for sterility in otic meds

Answer 35

benzalkonium chloride

EDTA

Question 36

What chemical is used for isotonicity in otic drug delivery

Answer 36

Sodium chloride

Question 37

What type of ingredient is used for viscosity in otic meds

Answer 37

increases contact time with ear canal
methylcellulose, hydroxycellulose
polyvinyl alcohol