Painful ears (otalgia) Flashcards
Otitis externa Furunculosis Bullous myringitis Barotrauma (aerotitis) TMJ dysfunction
What are the causes of otitis external?
Infection Conditions causing itch: - Psoriasis - Seborrhoeic dermatitis - Contact dermatitis - allergic + irritant High humidity Moisture Absence of wax Narrow ear canal Hearing aids
What are common causative organisms of OE
Pseudomonas
S aureus
How can OE present?
Ear pain
Itch
Discharge
What is seen on otoscopy in OE?
red swollen or eczematous canal
What is the initial management of oe
Ear irrigation
Analgesia for sx (P or I)
Topical abx +/- topical CS
What is management of severe OE w narrowed ear canal?
Ear wick
What are complications of OE?
malignant/necrotising OE
hearing loss and canal stenosis
When would you consider a biopsy in OE?
If it resistant to rx as can be a sign of malignancy
Who is at risk of developing malignant/necrotising OE?
diabetics
immunosuppressed
elderly
all w persistant unilateral OE
what is malignant/necrotising OE/
aggressive life threatening inf of the eternal ear that can lead to temporal bone destruction and osteomyelitis
What is usually the causative organism of malignant/necrotising OE?
Pseudomonas aeruginosa
What is the rx of malignant/necrotising OE
surgical debridement
systemic abx
specific Igs
possibly hyperbaric oxygen therapy
What is furunculosis?
painful staph abscess arising in a hair follicle
What is an important predisposing factor to furunculosis?
diabetes
What is the treatment of furunculosis w cellulitis present?
flucloxacillin
What is bullous myringitis?
haemorrhage blisters on deep meatal skin and on the drum
What usually causes bullous myringitis
influenza
mycoplasma pneumoniae
what is rx of bullous myringitis?
supportive e.g. pain relief
oral abx if middle ear effusion
What is barotrauma (aerotitis)
A general term for symptoms and disorders arising in the middle ears from changes in external pressure.
What are RFs for barotrauma?
conditions inhibiting function of the Eustachian tube e.g. inflammation, infection
What are the sx of aerotitis?
severe pain - drum becomes indrawn
if barotrauma to the inner ear - vertigo, tinnitus and deafness
What can be done to prevent aerotitis?
not flying w URTI decongestants into the nose repeated yawns swallows/jaws movements Inflating otovent device in air passengers w problems clearing ears
What is the rx of aerotitis?
supportive if simple
usually resolves by itself
What are the sx of TMJ dysfunction?
earache
facial pain
joint clicking/popping related tog riding teeth or joint derangement
STRESS - may become chronic pain syndrome
What are the signs of TMJ D?
joint tenderness exacerbated by lateral movement of the open jaw or trigger points in the pterygoids
What is rx of TMJ D?
Most improve w/o rx NSAIDs - po or topical e.g. diclofenac dental occlusion therapy CBT Physio Surgery
