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ENT > otitis externa > Flashcards

otitis externa Flashcards

1
Q

define otitis externa

localised
acute
chronic

A

Inflammation of the external canal – SWIMMER’S EAR

Localised – folliculitis
Diffuse – swimmer’s ear -) inflammation of skin and subdermis of the external ear canal

Duration – acute (3 weeks or less) and chronic (longer than 3 months)

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2
Q

define MOE

A

otitis externa spreads into the bone surrounding the ear canal (mastoid and temporal bones)

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3
Q

causes if OE

A

Acute
1) Bacteria – pseudomonas aeruginosa or staph aureus

2) Fungal – aspergillus or candida albicans
3) Seborrheic dermatitis maybe ass with
a. Dandruff
b. Blepharitis
c. Eyebrow scaling
d. Facial redness
e. Scaling
4) Contact dermatitis – topical med (NEOMYCIN)
a. Allergic – sudden inset -erythematous, itchy, oedematous and exudative lesions
b. Irritant – insidious onset with lichenification
5) Trauma – cotton buds, foregin objects
6) Envi factors – high temp/humidity, swimming in polluted water esp

Chronic

1) Allergic contact dermatitis
2) Irritant contact dermatitis
3) Seborrheic dermatitis
4) Fungal – prolonged and extensive use of topical Abx or steroids predispose to sec fungal infections
5) Bacterial persistent infection, thickening skin

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4
Q

Signs and symptoms of acute otitis externa

A

Signs

  • red, swollen, or eczematous with shedding of scaly skin
  • swelling in the ear canal – LOCALISED OTITIS EXTERNA with yellow or white centre filled with pus
  • discharge may be present (serous or purulent)
  • inflamed eardrum difficult to visualise

Symptoms

  • itchy
  • severe ear pain
  • hearing loss
  • pain made worse when tragus or pinna is moved or when inserting otoscope
  • tenderness on moving the jaw
  • tender regional lymphadenitis – less common
  • if furuncle breaks a relieve of pain (rare)
  • loss of hearing (rare)
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5
Q

signs and symptoms of chronic otitis externa

A

CHRONIC OTITIS EXTERNA

Signs

  • lack of earwax
  • dry hypertrophic skin - partial canal stenosis
  • pain on manipulation

symptoms

  • constant itch in the ear
  • mild discomfort
  • pain, if present
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6
Q

signs and symptoms of MOE

A

signs

  • granulation tissue at bone-cartilage junction, exposed bone at the ear canal
  • facial drooping
  • fever above 38

symptoms

  • vertigo, dizzy
  • hearing loss
  • pain and headache
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7
Q

differentials for OE

A 
AOM
Cholesteatoma
MOE
trauma
barotrauma
skin conditions 
mastoiditis 
referred pain
ramsay hunt syndrome
impacted ear wax
foreign body in the ear
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8
Q

initial management for OE

A

manage any aggravating or precipitating factors

Consider cleaning the external auditory ear canal if earwax or debris obstructs the application of topical medication

  • syringing or irrigation
  • dry swabbing
  • microsuction

analgesia

topical antibiotic or a combined topical antibiotic with a steroid
- Flucoxacillin
topical AB with steroids
Quinolone - ciprofloxacin Pseudomonas is suspected 7 days 2 times - can use it with TM perforation
acetic acid

if the tympanic membrane is perforated aminoglycosides are traditionally not used*

if the canal is extensively swollen then an ear wick is sometimes inserted

analgesia

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9
Q

when to consider oral ABs

A

systemically unwell
immunocompromised
cellulitis extending

PRIMARY CARE FLUCOXACILLIN 7 DAYS

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10
Q

self care advise for pts w OE

A

keep the ears dry - do not go swimming wear plugs or tight cap

dry with hair dryer

avoid trauma to ear canal
acidifying drops before after swim

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11
Q

treatment for chronic OE

A 
-	Fungal – topical antifungal
o	Clotrimazole 1%
o	Clioquinol and a corticosteroid
-	Allergic – corticosteroid
-	Seborrheic – antifungal.corticosteroid combination
-	No cause evident
o	7 day corticosteroid with acetic spray 
o	FAIL TOPICAL ANTIFUNGAL
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12
Q

Risk factors for MOE

A
  • Diabetes mellitus — present in most cases of malignant otitis.
  • Compromised immunity, such as from HIV/AIDS, chemotherapy, or chronic kidney disease.
  • Radiotherapy to the head or the neck.
  • Aural irrigation with tap water, especially in people with other risk factors.
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13
Q

Complciations of OE

A

• Abscess.
• Chronic otitis externa.
• Regional dissemination of infection with: auricular cellulitis, chondritis, parotitis, spreading cellulitis.
• Fibrosis, leading to stenosis of the ear canal and conductive deafness.
• Myringitis (inflammation of the tympanic membrane).
• Tympanic membrane perforation.
• Malignant otitis.
The complications of malignant otitis include:
• Facial nerve paralysis.
• Meningitis

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14
Q

role of ear wax

A

Protects the EAC skin.

  • Cleans and lubricates the skin.
  • Antiseptic properties.
  • Insect stopped
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15
Q

what is irrigation

A

A mechanical irrigation system flushes the wax out with warm water. Similarly, the ear can be syringed.

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16
Q

what is tympanosclerosis

A

scarring of the eardrum, which may occur after injury or surgery.

17
Q

tympanosclerosis on otoscopy

A

right white scarring on the membrane

18
Q

second line management for OE

A

consider contact dermatitis secondary to neomycin

oral antibiotics (flucloxacillin) if the infection is spreading

taking a swab inside the ear canal

empirical use of an antifungal agent

19
Q

key features in history for malignant otitis externa

A

Diabetes (90%) or immunosuppression (illness or treatment-related)

Severe, unrelenting, deep-seated otalgia

Temporal headaches

Purulent otorrhea

Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

20
Q

diagnosis of MOE

A

CT scan

21
Q

management of MOE

A
  • non-resolving otitis externa with worsening pain should be referred urgently to ENT
  • Intravenous antibiotics that cover pseudomonal infections CIPROFLOXACIN
22
Q

what is furunculosis

A

infection of a hair follicle in the outer ear canal

23
Q

clinical features of furnuculosis

A

Severe throbbing pain with pyrexia precedes rupture of the abscess

24
Q

management of furnuculosis

A

Examination and drainage under anaesthetic may be required.

25
Q

what is myringitis bullosa

A

localized form of otitis externa where blisters form

on the eardrum and deep meatus.

26
Q

what is acute otitic barotrauma

A

descent in aircraft. It leads to severe otalgia and occasionally rupture of the eardrum with a bloody otorrhoea.

27
Q

causes of referref otalgia in children

A

tonsillitis referred pain
URTI
dental pain

28
Q

periauricular sinus

A

Common congenital condition in which an epithelial defect forms around the external ear

Small sinuses require no treatment

Deeper sinuses may become blocked and develop episodes of infection, they may be closely related to the facial nerve and are challenging to excise

29
Q

risk factors for OE

A

Radiotherapy to the ear, neck or head.
Previous ear surgery, such as tympanostomy.
Previous topical treatments for otitis externa or otitis media.
Atopic, allergic, or irritant dermatitis.
Dermatoses.
Trauma to ear canal from cleaning, scratching, or instrumentation.
Use of hearing aid or ear plugs.
Exposure to water or humid climate.
Diabetes, immunosuppression, and older age.
irrigation
chemical injury

30
Q

management for chronic otitis externa
fungal cause
dermatitis
no cause identified

A

fungal cause

  • clotrimazole
  • acetic acid
  • clioquinol

dermatitis
irritant/allergic - topical steroid
seborrhoeic - cloquinol adn corticosteroid

no cause
- topical steroid no AB

31
Q

when can TM perforation be assumed

A

Has had a tympanostomy tube inserted in the past 12 months and there is no documentation of extrusion and closure of the tympanic membrane.

Can blow air out of the ear when the nose is pinched, or

Can taste medication placed in the ear.

32
Q

when to swab ear from someone with OE

A

Treatment fails.

Otitis externa is recurrent or chronic.

Topical treatment cannot be delivered effectively (for example, if the ear canal is occluded due to swelling or debris).

The infection has spread beyond the external auditory canal.

The condition is severe enough to require oral antibiotics.

33
Q

what is mild case of otitis externa and treatment

A

mild discomfort and/or pruritus; no deafness or discharge), consider prescribing topical acetic acid 2% spray.
When features of more severe inflammation are present, such as in this case, they advise 7 days of a topical antibiotic with or without a topical steroid.

ENT (15 decks)

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