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Head and Neck/ ENT > Otitis Externa > Flashcards

Otitis Externa Flashcards

1
Q

What is Otitis Externa?

A
  • This is the inflammation of the skin in the external ear canal
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2
Q

What determines the difference between acute otitis externa and chronic otitis externa?

A
  • Acute <3 weeks
  • Chronic >3 weeks
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3
Q

What is another name for Otitis Externa?

A
  • Swimmer’s Ear
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4
Q

What are predisposing factors for Otitis Externa?

A
  • Exposure to water
  • Trauma in the ear canal
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5
Q

What is protective against Otitis Externa?

A
  • Ear Wax
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6
Q

What are some of the causes of Otitis Externa?

A
  • Bacterial Infection
  • Fungal Infection (aspergillus/ candida) - multiple courses of topical antibiotics. Antibiotics kill off the friendly bacteria which have a protective effect against fungal infections
  • Eczema
  • Seborrhoeic Dermatitis
  • Contact Dermatitis
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7
Q

What are the bacterial causes of Otitis Externa?

A
  • Pseudomonas Aeruginosa
  • Staphylococcus Aureus
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8
Q

What is important to know about Pseudomonas Aeruginosa ?

A
  • Gram-negative aerobic rod shaped bacteria
  • Can colonise the lungs in patients with cystic fibrosis
  • naturally resistant to many antibiotics and can be treated with gentamicin/ ciprofloxacin
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9
Q

How does Otitis Externa Present?

A
  • Ear Pain
  • Discharge
  • Itchiness
  • Conductive Hearing Loss
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10
Q

What would be seen on examination for Otitis Externa?

A
  • Erythema/ Swelling of the ear canal
  • Tenderness of the ear canal
  • Pus/ Discharge in the ear canal
  • Lymphadenopathy
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11
Q

How can Otitis Externa be diagnosed ?

A
  • Otoscopy
  • Ear Swab (to determine causative organism)
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12
Q

What is the managment of mild Otitis Externa?

A
  • Acetic Acid 2% (anti fungal and antibacterial effect)
  • can be used prophylactically before and after swimming in patients who are prone to otitis Externa
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13
Q

What is Malignant Otitis Media?

A
  • This is an uncommon type of Otitis Externa that is found in immunocompromised individuals (diabetic patients)
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14
Q

What is the common causative organism in Malignant Otitis Externa?

A
  • Pseudomonas Aeruginosa
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15
Q

What is the Pathophysiology of Malignant Otitis Externa?

A
  • Infection occurs in the external auditory meatus in the soft tissue
  • This progresses to involve the soft tissues into the bony ear canal
  • Progresses to temporal bone osteomyelitis
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16
Q

What are the key features in the history of malignant Otitis Externa?

A
  • Diabetes/ Immunosuppression
  • Severe/ unrelenting/ Deep-seated Otalgia
  • Temporal Headaches
  • Purulent Otorrhea
  • Possibly dysphasia, hoarseness, or facial nerve dysfunction
17
Q

What investigations can be done for Otitis Externa?

A
  • CT scan
18
Q

What is the treatment for Malignant Otitis Externa?

A
  • ENT Admission
  • IV Antibiotics
  • Imaging ( CT/ MRI) to assess the extent of the infection
19
Q

When should there be a referral to ENT?

A
  • non-resolving otitis Externa with worsening pain
20
Q

What is the treatment for moderate Otitis Externa?

A
  • topical antibiotic and steroid: (neomycin, dexamethasone and acetic acid), (neomycin and betamethasone), (gentamicin and hydrocortisone), (ciprofloxacin and dexamethasone)
21
Q

What are the side effects of Aminoglycosides?

A
  • Potentially Ototoxic if they are able to get past the tympanic membrane
  • It is essential to exclude a perforated tympanic membrane before using topical aminoglycosides in the ear
  • Refer a patient for Micro-suction of the debris from the canal to help visualise the tympanic membrane
  • ## Refer the patient if the canal is so blocked/ swollen and topical treatments cannot reach the site of infection
22
Q

What is the treatment for severe Otitis Externa?

A
  • oral antibiotics
  • discussion for ENT admission with IV antibiotics
  • Ear Wick - used in the canal when it is very swollen and treatment with ear drops or sprays may be difficult ( contains topical treatments for otitis Externa - antibiotics and steroids)
  • Wicks are inserted into the ear canal and left there for a period of time
  • As the swelling and inflammation settle, the ear wick can be removed and treatment can continue with drops or sprays
23
Q

What is the treatment for fungal Infection of the ear?

A
  • Clotrimazole
24
Q

What are the complications of malignant otitis Externa?

A
  • Facial nerve damage and palsy
  • Other cranial involvement (glossopharyngeal, vagus or accessory nerves)
    -Meningitis
  • Intracranial thrombosis
  • Death

Head and Neck/ ENT (17 decks)

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