Otitis externa Flashcards
Otitis externa, commonly referred to as swimmer’s ear, is an inflammatory condition affecting the external auditory canal and pinna. What is the prevalence of this?
1 - 5000 cases per 100,000
2 - 500 cases per 100,000
3 - 50 cases per 100,000
4 - 5 cases per 100,000
2 - 500 cases per 100,000
Common problem affecting boys and girls equally
Otitis externa, commonly referred to as swimmer’s ear, is an inflammatory condition affecting the external auditory canal and pinna. What age does the prevalence of this peak?
1 - 1-5
2 - 10-20
3 - 30-40
4 - 40-50
4 - 40-50
The pinna is the medical name of the outer ear
Otitis externa can be acute or chronic. What is the definition of acute Otitis externa?
1 - <2 weeks
2 - <6 weeks
3 - <12 weeks
4 - <16 weeks
2 - <6 weeks
Chronic Otitis externa = >3months
There are a myriad of factors that can increase the risk of otitis externa. Which of the following is NOT a risk factor for developing otitis externa?
1 - water exposure
2 - high humidity
3 - male gender
4 - trauma to the auditory canal (cotton wool ear buds)
5 - narrow ear canals
6 - immunosuppression
3 - male gender
immunosuppression is a risk factor for otitis externa, but which of the following conditions is otitis externa most common in?
1 - RA
2 - coeliac disease
3 - diabetes
4 - IBD
3 - diabetes
Which of the following are common causes of otitis externa?
1 - infection
2 - seborrhoeic dermatitis
3 - contact dermatitis (allergic and irritant)
4 - all of the above
4 - all of the above
Seborrhoeic dermatitis causes red, flaky and itchy rash on your skin. It affects areas of your skin that tend to be greasier, like your face, scalp and chest. It’s also known as seborrhoeic eczema
Which of the following skin conditions is most commonly associated with otitis externa?
1 - seborrhoeic dermatitis
2 - psoriasis
3 - uriticaria
4 - acne vulgaris
1 - seborrhoeic dermatitis
Infection is a common cause of otitis externa. Which 2 bacteria are commonly associated with otitis externa?
1 - Staphylococcus aureus
2 - Group A ß - hemolytic streptococcus
3 - Streptococcus pneumoniae (Strep)
4 - Pseudomonas aeruginosa
1 - Staphylococcus aureus
4 - Pseudomonas aeruginosa
MUST get a swab for microscopy, culture and sensitivity
Which 2 fungi have been associated with causing chronic otitis externa?
1 - Dermatophytes
2 - Tinea barbae
3 - Aspergillus species
4 - Candida albicans
3 - Aspergillus species
4 - Candida albicans
MUST get a swab for microscopy, culture and sensitivity
Which of the following are common symptoms in patients describe if they have otitis externa?
1 - otalgia (ear pain)
2 - pruritis (itchy ear)
3 - otorrhea (ear discharge)
4 - reduced hearing
5 - all of the above
5 - all of the above
Is the hearing loss in otitis externa conductive or sensorineural in nature?
- conductive
When comparing otitis externa and media, which of theses will present with a painful ear when you touch of pull the pinna?
- otitis externa
When comparing otitis externa and media, which of theses is more likely to present with an exudate?
- otitis externa
BUT otitis media can present with exudate if the tympanic membrane is perforated
When comparing otitis externa and media, which of theses is more likely to present with an erythematous external auditory canal?
- otitis externa
Is it always possible to get a clear view of the ear canal in otitis externa?
- no
Maybe obscured due to discharge, debris or swelling
Ear canal may be red, swollen, or eczematous
Which of the following are recommended 1st line in patients with suspected otitis externa?
1 - acetic acid spray for 7 days
2 - removal of debris if canal is obstructed
3 - ear wick to reduce inflammation and swelling
4 - all of the above
4 - all of the above
MUST KEEP EAR DRY
In otitis externa, which of the following is the first line treatment?
1 - gentamicin with dexamethasone
2 - neomycin with dexamethasone
3 - flumetasone with dexamethasone
4 - co-amoxiclav with dexamethasone
2 - neomycin with dexamethasone
Typically given for 7-14 days as a topical otomize ear spray containing:
- dexamethasone (steroid)
- neomycin sulphate (antibiotic)
- acetic acid
In otitis externa, if the infection becomes resistant or severe, which of the following antibiotics are typically given orally?
1 - gentamicin
2 - neomycin
3 - ciprofloxacin
4 - co-amoxiclav
3 - ciprofloxacin
if a patient has suspected otitis externa and a perforated tympanic membrane, which antibiotic is typically NOT used?
1 - gentamicin
2 - flucloxacillin
3 - flumetasone
4 - co-amoxiclav
1 - gentamicin
Gentamicin is an aminoglycosides
- associated with ototoxicity and hearing loss
Flucloxacillin can be used as a 2nd line antibiotic if the infection is spreading
Necrotising Otitis Externa (NOE)is the spread of infection causing osteomyelitis of the surrounding bones (temporal bone). Which of the following is NOT a typical risk factor for NOE?
1 - immunosuppression, Diabetes Mellitus (esp. poorly controlled)
2 - Elderly
3 - Younger ages (<5)
4 - all of the above
3 - Younger ages (<5)
Look for history of diabetes and diabetes medication in stem as this often gives clues to the diagnosis
Necrotising Otitis Externa (NOE)is the spread of infection causing osteomyelitis of the surrounding bones (temporal bone). NOE can cause granulation tissue in floor of external ear canal (usually bony-cartilaginous junction). Which of the following is NOT a red flag in patients?
1 - disproportionate ear pain and fever
2 - profound sensorineural hearing loss
3 - ipsilateral facial nerve palsy
4 - all of the above are red flags
2 - profound sensorineural hearing loss
This causes conductive hearing loss
Necrotising Otitis Externa (NOE)is the spread of infection causing osteomyelitis of the surrounding bones (temporal bone). NOE can cause granulation tissue in floor of external ear canal (usually bony-cartilaginous junction). It can cause nerve palsies in all of the following cranial nerves, EXCEPT which one?
1 - CN7
2 - CN8
3 - CN9
4 - CN10
5 - CN11
6 - CN12
2 - CN8
This is internal ear, so is less likely to be affected
Necrotising Otitis Externa (NOE)is the spread of infection causing osteomyelitis of the surrounding bones (temporal bone). NOE can cause granulation tissue in floor of external ear canal (usually bony-cartilaginous junction). Which of the following is MOST likely to suggest this is NOE more than just otitis externa?
1 - colour of exudate
2 - duration of symptoms
3 - proportion of pain in relation to symptoms
4 - age at onset of symptoms
3 - proportion of pain in relation to symptoms
Which of the following blood tests would NOT be routinely performed in a patient suspected of having Necrotising Otitis Externa (NOE)?
1 - FBC
2 - Autoimmune screening
3 - U/Es
4 - CRP/ESR
5 - Blood cultures
2 - Autoimmune screening
ESR is specifically good as it can be used as a marker of antibiotic response
Would also want to sample the granulation tissue in the ear to exclude small cell carcinoma
Which of the following imaging modalities is most likely to be performed in a patient with suspected Necrotising Otitis Externa (NOE)?
1 - angiogram
2 - head MRI
3 - head X-ray
4 - head CT
4 - head CT
Specifically interested in the temporal bone
When treating Necrotising Otitis Externa (NOE) the local microbiologist should be consulted on antibiotic prescription. Typically how long do these patients take antibiotics for?
1 - 2 weeks
2 - 6 weeks
3 - 12 weeks
4 - 24 weeks
2 - 6 weeks
Must get control of blood sugars and provide analgesia as well
Are oral antibiotics useful in treating Necrotising Otitis Externa (NOE)?
1 - Self care: clean + dry ear
2 - acetic acid spray (max 7 days)
3 - Analgesia
4 - Consider Antibiotics (topical antibiotics +/- steroid for 7-14 days – e.g. otomize spray)
5 - Surgery
6 - Oralantibiotics in severe/resistant cases e.g. ciprofloxacin
5 - Surgery
Antibiotics Need to use topical and sometimes systemic via IV as well. Oral antibiotics are typically not great
Which of the following is NOT a management approach in patients with Necrotising Otitis Externa (NOE)?
In Necrotising Otitis Externa (NOE) patients can suffer with facial nerve palsy. Which of the following should patients receive?
1 - lubricating eye drops
2 - lubricating eye drops and tape eyes at night
3 - chloramphenicol
4 - intravenous acetazolamide
2 - lubricating eye drops and tape eyes at night
Patients are unable to close their eyes
In Necrotising Otitis Externa (NOE) patients can suffer with glossopharyngeal nerve palsy. Which of the following should they receive if this is the case?
1 - liquid only diet
2 - soft food and liquid diet
3 - enteral feeding
4 - parenteral nutrition
3 - enteral feeding
PEG feeding is an example of this
Common side effect is diarrhoea
Does Necrotising Otitis Externa (NOE) have a good mortality rate?
- no
Despite treatment, mortality rates are poor
