Otorrhoea Flashcards
What protects the outer ear from infection?
- Wax (cerumen)
- The shape of the canal
- Skin - epithelial migration to the external auditory meatus
- Hair
What are the risk factors for developing otitis externa?
- Allowing water to enter the ear
- Instrumentation of the ear canal e.g. cotton buds
- Skin conditions e.g. eczema and psoriasis
What are the 3 most common causes of otitis externa?
- Staphylococcus aureus (bacteria)
- Aspergillus niger (fungi)
- Pseudomonas aeriguinosa (bacteria)
What are the signs on examination of otitis externa?
- Swelling (oedema)
- Itching
- Watery discharge
- Otalgia
- Erythema of the surrounding skin
- Lymph node swelling (pre and post auricular commonly)
Which patients are at risk of developing osteomyelitis if they get otitis externa (malignant otitis externa)?
Diabetic patients
Immunosuppressed patients
How would you treat a simple bacterial otitis externa infection?
- Oral analgesia
- Topical antibiotic drop with steroid
- Keeping the ear dry
What is perichondritis?
Inflammation of cartilage AKA cauliflower ear
How would you treat someone with complicated otitis externa with perichondritis?
- Gentle micro-suction of the ear
- Continuation of topical drops with insertion of an aural wick (aural tampon)
- Admission of the patient to hospital and provision of IV Abx
What are the early complications of acute otitis externa?
- Facial cellulitis
2. Otomycosis (fungal infection)
What are the late complications of acute otitis externa?
- Canal stenosis with hearing loss
2. Osteomyelitis
When should you presume osteomyelitis in a patient who is immunocompromised or has diabetes with otitis externa?
If the infection persists for 2 weeks
How do we treat otitis externa with temporal bone osteomyelitis?
IV Abx for at least 6 weeks
If someone presents with discharging ear (otorrhoea) what are the important parts of the history to cover?
- Duration
- Otalgia
- Texture, colour and smell of the discharge
- Hearing loss?
- Balance
- Tinnitus
- Treatments received and their impact
- Hobbies - swimming most important to ask about
- Have they had surgery in the ear?
- Any other significant PMH?
What can cause a perforated round window?
Rapid changes in pressures (barotrauma)
What can cause a perforation in the tympanic membrane?
- Recurrent infection
- Iatrogenic causes (surgery etc)
- Trauma
What are the 4 most common organisms involved in chronic otitis media?
- Pseudomonas aeruginosa
- Staphylococcus aureus
- Streptococcus
- Anaerobic bacteria
How do we medically manage a perforation in the tympanic membrane?
- Micro-suction and inspection of the ear under the microscope
- Topical Abx and steroid drop: 7-10 days if active infection
- Strict water precautions
How do we surgically manage a perforation in the tympanic membrane?
Myringoplasty - repair of the eardrum
What is a cholesteatoma?
This is a deep retraction of the tympanic membrane due to an accumulation of keratin which develops into a cyst as the keratin cannot migrate out of the ear canal
What is a glomus jugulare?
A vascular tumour which presents as a red mass behind an intact tympanic membrane
What might a patient complain of if they have a glomus jugulare?
Pulsatile tinnitus
How would you manage a patient with cholesteatoma?
- Pure tone audiogram
- Topical Abx and steroid drop
- Close inspection of the ear
How do we surgically manage a cholesteatoma?
Mastoidectomy - opening of the mastoid air cells, remove the cholesteatoma from the middle ear and reconstruction of the ossicles and tympanic membrane
Define acute otitis media (AOM)?
An acute inflammatory process in the middle ear.
