OW Charlie bit my ear

Question 1

what can cause ear pain? BROAD categories

Answer 1

disease affecting:

• external ear
• middle ear
• inner ear

Question 2

What makes up the differential diagnosis for ear pain?

Answer 2

• Acute otitis media
• otitis externa
• Furuncule
• malignant disease

None ear tings

• dental pathology
• TMJ dysfunction
• OA of C spine
• pharyngeal infection

Question 3

What symptoms would make one think of otitis externa?

Answer 3

• severe painful discharging ear
• worse at night
• Hx of eczema or dermatitis
• itching on the external auditory canal

Question 4

What are the potential causes of otitis externa?

Answer 4

• uncomplicated bacterial
• fungal
• VZV reactivation (ramsay hunt syndrome)

Question 5

What is the management for otitis externa?

Answer 5

• microsuction
• pope wick
• topical Abx (or antifungals)
• water precautions - KEEP EM DRY

Question 6

What’s a furnuncle and how dya treat it?

Answer 6

• staph abscess on a hair focllicle in the ear
• V tender w/ dry ear
• I&D, fluclox and wick insertion

Question 7

What is Ramsay hunt syndrome?

Answer 7

• VZV (maybe HSV) activation
• sever pain
• TM/pinna vesicles
• CN VII palsy
• hearing loss

Question 8

How do you treat ramsay hunt syndrome?

Answer 8

• corticosteroids
• antivirals
• eye protection

Question 9

what’s the worse sort of otitis externa? what causes that bad bad boy?

Answer 9

• Malignant otitis externa
• Osteomyelitis of the EAM and bony tympanic membrane
• Pseudomonas

Question 10

What are the symptoms of Malignant otitis externa? and who is the typical patient?

Answer 10

• severe otalgia
• lots of purulent discharge
• granulations in the EAM
• Elderly diabetic patients

Question 11

What are the symptoms of Acute otitis media?

Answer 11

• otalgia
• repeated rubbing or tugging of the affected ear
• hearing loss
• systemic features - fever, malaise, irritability, poor sleep
• Hx of URTI

(some Sx are for kiddies)

Question 12

What findings on otoscopy can you expect in AOM?

Answer 12

• bulging tympanic membrane
• loss of light reflex
• red tympanic membrane

Question 13

What are the Tx principles for acute otitis media?

Answer 13

• hard to tell the difference between a viral and bacterial infection
• not all cases need Abx Tx
• most cases spontaneousy resolve in 3-7 days
• can give back up Abx
• can tell them to come back if Sx worsen significantly
• regular paracetamol or ibruprofen

Question 14

Who are you more likely to give Abx too?

Answer 14

• any age with ottorhoea
• bilateral infection
• systemically very unwell
• presence of or high risk of complications
• BAHA

Question 15

What are the management options in recurrent AOM?

Answer 15

• gromet insertion

- prophylactic Abx

Question 16

Symptoms of mastoiditis? Tx?

Answer 16

• boggy swelling behind the ear with al the Sx of an ear infection
• admit to hospital and IV abx
• ?neurosurgical input