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ENT (ear) > Otitis Externa > Flashcards

Otitis Externa Flashcards

1
Q

Define otitis externa

A

An inflammation of the skin lining the external canal

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2
Q

What causes otitis externa?

A

Most often infection - bacterial or fungal

Can by caused by allergies, irritants or inflammatory conditions - seborrhoeic dermatitis or contact dermatitis

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3
Q

What is OE occasionally known as?

A

Swimmer’s ear

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4
Q

What symptoms are associated with otitis externa?

A

Pain
Itchy ear
Discharge
Hearing loss - from discharge present in the ear canal

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5
Q

What signs are found on otoscopy?

A

Ear canal with erythema, oedema, exudate
Pain on moving tragus or auricle
Pre auricular lymphadenopathy

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6
Q

Approximately what percentage of infections are bacterial?

A

90%

10% are fungal

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7
Q

Most cases of bacterial infection involve what bacteria?

A

Staphylococcus aureus

Pseudomonas aeruginosa

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8
Q

What usually causes fungal infection?

A

Aspergillus species

Candida species

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9
Q

What are some risk factors?

A

Hot and humid climate
Swimming
Older age
Immunocompromised
DM
Narrowed EAM - hereditary or acquired through chronic infection
Insufficient wax - reduced protection
Excessive wax - obstruction, retention of debris
Dermatological conditions - eczema, seborrhoeic dermatitis
Dermatitis affecting canal
Radiotherapy to ear, neck or head

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10
Q

What is malignant otitis externa?

A

A particularly aggressive infection mainly seen in diabetics or immunocompromised patients where the infection spreads from soft tissue of ear canal into the bone
Pseudomonas aeruginosa is causative in 95%

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11
Q

How does malignant otitis externa typically present?

A

Chronic ear discharge despite topical treatment
Deep seated severe ear pain
Cranial nerve palsies (mostly CNVII)

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12
Q

How should malignant OE be managed?

A

Aggressive treatment with IV antibiotics

Plus topical treatment

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13
Q

What’s the mortality rate of malignant OE?

A

10% despite aggressive treatment

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14
Q

What is the management for OE?

A 
Analgaesia 
Local heat 
Topical antibiotic or combined topical antibiotic with a steroid for minimum of 7 days, but if symptoms persist continue until resolve (max 14 days) 
If canal debris consider removal 
Ear wick if swollen canal 
Swab discharge in resistant cases
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15
Q

When should acetic acid be used?

A

Mild cases

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16
Q

Patients prescribed antibiotic/steroid drops can expect symptoms to last how many days once treatment begun?

A

6 days

17
Q

When are oral antibiotics indicated?

A

Systemically unwell
Pre auricular lymphadenopathy
Evidence of spreading infection beyond canal e.g to pinna, neck or face
DM or immunocompromised

18
Q

If systemic antibiotics indicated, what is usually used?

A

Flucloxacillin - infection usually due to S. aureus
Or clarythromycin if penicillin allergic
7 day course

19
Q

What general advise should be given?

A

Keep ear dry

Avoid cotton wool to plug discharging ear

20
Q

When is it considered chronic?

A

Persists for more than 3 months

21
Q

If the tympanic membrane is perforated, what antibiotic class is typically not used?

A

Aminoglycosides - concerns about ototoxicity

22
Q

What are some differentials?

A

OM
Perforation
Ramsey Hunt syndrome
Furuncle- infection of hair follicle

23
Q

What is a furuncle?

A

Small, localised infection with severe pain in ear and local swelling of canal
If lesion bursts there is sudden pain relief

24
Q

If the discharge is thick white/grey with spores, what may this indicate?

A

Fungal infection

25
Q

What should be done on examination?

A

Examine ear canal, tympanic membrane, auricle, cervical lymph nodes
Examine surrounding tissue for dermatological conditions

26
Q

Otitis externa can cause significant canal oedema, preventing topical treatment with antibiotic and steroid drops. What should be done in this case?

A

Referral to ENT - microsuction and insertion of a pope wick needed - to expand the ear canal

27
Q

What should be done in cases of non resolving otitis externa with worsening pain?

A

Urgent ENT referral - suggests malignant (necrotising) OE

28
Q

What should be done if patient fails to respond to topical antibiotics?

A

Referral to ENT

ENT (ear) (25 decks)

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