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ENT > Otitis Externa > Flashcards

Otitis Externa Flashcards

1
Q

What is Otitis Externa?

A
  • Inflammation of outer ear (auricle, external auditory canal, outer surface of eardrum)
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2
Q

What is acute diffuse OE also known as?

A
  • swimmer’s ear
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3
Q

What are the RF for OE?

A
  • Hot and humid climates.
  • Swimming.
  • Older age.
  • Immunocompromise (eg, HIV).
  • Diabetes mellitus.
  • Narrow external auditory meatus
  • Obstruction of normal meatus - eg, keratosis obturans, foreign body, hearing aid
  • Insufficient wax
  • Wax build-up
  • eczema,
  • irritant dermatitis
  • Trauma to ear canal - eg, from cotton buds, radiotherapy.
  • active otitis media,
  • Pseudomonas aeruginosa or fungi.
  • Previous tympanostomy.
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4
Q

How does insufficient wax cause OE?

A
  1. Too little cerumen (often through over-cleaning)
  2. Reduces the protective function of cerumen
  3. canal pH rise.
  4. predispose to infection
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5
Q

How does wax build up cause OE?

A
  1. excessive cerumen
  2. lead to obstruction, retention of water and debris, and infection.
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6
Q

What is cerumen (ear wax) compost of?

A
  • epithelial cells
  • lysozymes
  • oily secretions from sebaceous and ceruminous glands
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7
Q

What is the function of cerumen?

A
  • cleaning
  • lubrication
  • protection from bacteria, dust and insect
  • creates an acidic coat which also helps to inhibit bacterial and fungal growth
  • hydrophobic properties also prevent water from reaching the canal skin and causing maceration
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8
Q

What causes OE?

A
  • Bacterial infection (90%)
    • Pseudomonas Aeruginosa
    • Staph aurues
  • Fungal infection (10%)
    • Aspergillus
  • Herpes zoster - Ramsay Hunt syndrome
  • Skin inflammation
    • Seborrhoeic dermatitis
    • Acne
    • Psoriasis
    • Atopic eczema
    • SLE
  • irritants
    • hearing aids, swimming, cotton buds
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9
Q
A
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10
Q

What are the sx of OE?

A
  • Ear specific
    • pain
    • itching
    • hearing loss
    • discharge
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11
Q

What are the findings of OE on otoscopy?

A
  • Ear canal with erythema, oedema and exudate.
  • Mobile tympanic membrane.
  • Pain with movement of the tragus or auricle.
  • Pre-auricular lymphadenopathy
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12
Q

What are the sx and signs of acute diffuse OE?

A
  • Moderate temperature (less than 38°C)
  • lymphadenopathy.
  • Swelling is diffuse.
  • Pain
  • pruritus.
  • Moving the ear or jaw is painful.
  • slight thick discharge, +/- bloody
  • Hearing may be impaired.
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13
Q

What is swimmer’s ear also known as?

Do you have to be a swimmer to get this?

A
  • acute OE brought on by water remaining in ear after swimming
  • no
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14
Q

What are the RF for chronic OE?

A
  • fungal infection
  • immunocompreomised
  • diabetes
  • prolong abx ear drop use
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15
Q

What is necrostising otitis externa?

A
  • life-threatening extension of otitis externa into the mastoid and temporal bones
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16
Q

What organism commonly causes necrotising OE?

A
  • P. Aeuruginosa
  • Staph aureus
17
Q

What are the sx of necrotising OE?

A
  • Pain and headache of greater intensity than clinical signs would suggest
  • Oedema.
  • Exudate.
  • Granulation tissue (may be present at the junction of bone and cartilage)
18
Q

What ix would you perform for OE?

A
  • Swabs - if tx failure
  • Assess integrity of tympanic membrane
19
Q

How do you test whether tympanic membrane has perforated?

A
  • Can taste medication placed in the ear; or
  • Can blow air out of the ear when the nose is pinched; or
  • Has a tympanostomy tube in situ
20
Q

What are the differential diagnosis of OE?

A
  • Foreign body
  • Impacted wax
  • Otitis media
  • Cholesteatoma
  • Chronic suppurative otitis media
21
Q

How would you mx acute OE?

A
  • topical drops
  • removal of debris
  • oral abx if
    • cellulits
    • cervical lymphadenopathy
22
Q

How would you mx chronic OE?

A
  • acetic acid 2% - 7 days + corticosteroid eardrops
  • clotrimazole (topical antifungal) if fungal growth suspected
  • tacrolimus
23
Q

How would you mx malignant OE?

A
  • Quinolones (6-8 weeks)
  • Urgent referral to ENT
24
Q

What are the cx of OE?

A
  • temporary hearing loss/muffling
  • cellulitis
  • necrotising OE

ENT (3 decks)

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