Painful ears (otalgia)

Question 1

What are the causes of otitis external?

Answer 1

Infection 
Conditions causing itch:
- Psoriasis  
- Seborrhoeic dermatitis
- Contact dermatitis - allergic + irritant 
High humidity
Moisture
Absence of wax
Narrow ear canal 
Hearing aids

Question 2

What are common causative organisms of OE

Answer 2

Pseudomonas

S aureus

Question 3

How can OE present?

Answer 3

Ear pain
Itch
Discharge

Question 4

What is seen on otoscopy in OE?

Answer 4

red swollen or eczematous canal

Question 5

What is the initial management of oe

Answer 5

Ear irrigation
Analgesia for sx (P or I)
Topical abx +/- topical CS

Question 6

What is management of severe OE w narrowed ear canal?

Answer 6

Ear wick

Question 7

What are complications of OE?

Answer 7

malignant/necrotising OE

hearing loss and canal stenosis

Question 8

When would you consider a biopsy in OE?

Answer 8

If it resistant to rx as can be a sign of malignancy

Question 9

Who is at risk of developing malignant/necrotising OE?

Answer 9

diabetics
immunosuppressed
elderly
all w persistant unilateral OE

Question 10

what is malignant/necrotising OE/

Answer 10

aggressive life threatening inf of the eternal ear that can lead to temporal bone destruction and osteomyelitis

Question 11

What is usually the causative organism of malignant/necrotising OE?

Answer 11

Pseudomonas aeruginosa

Question 12

What is the rx of malignant/necrotising OE

Answer 12

surgical debridement
systemic abx
specific Igs
possibly hyperbaric oxygen therapy

Question 13

What is furunculosis?

Answer 13

painful staph abscess arising in a hair follicle

Question 14

What is an important predisposing factor to furunculosis?

Answer 14

diabetes

Question 15

What is the treatment of furunculosis w cellulitis present?

Answer 15

flucloxacillin

Question 16

What is bullous myringitis?

Answer 16

haemorrhage blisters on deep meatal skin and on the drum

Question 17

What usually causes bullous myringitis

Answer 17

influenza

mycoplasma pneumoniae

Question 18

what is rx of bullous myringitis?

Answer 18

supportive e.g. pain relief

oral abx if middle ear effusion

Question 19

What is barotrauma (aerotitis)

Answer 19

A general term for symptoms and disorders arising in the middle ears from changes in external pressure.

Question 20

What are RFs for barotrauma?

Answer 20

conditions inhibiting function of the Eustachian tube e.g. inflammation, infection

Question 21

What are the sx of aerotitis?

Answer 21

severe pain - drum becomes indrawn

if barotrauma to the inner ear - vertigo, tinnitus and deafness

Question 22

What can be done to prevent aerotitis?

Answer 22

not flying w URTI
decongestants into the nose
repeated yawns
swallows/jaws movements 
Inflating otovent device in air passengers w problems clearing ears

Question 23

What is the rx of aerotitis?

Answer 23

supportive if simple

usually resolves by itself

Question 24

What are the sx of TMJ dysfunction?

Answer 24

earache
facial pain
joint clicking/popping related tog riding teeth or joint derangement
STRESS - may become chronic pain syndrome

Question 25

What are the signs of TMJ D?

Answer 25

joint tenderness exacerbated by lateral movement of the open jaw or trigger points in the pterygoids

Question 26

What is rx of TMJ D?

Answer 26

Most improve w/o rx
NSAIDs - po or topical e.g. diclofenac 
dental occlusion therapy 
CBT
Physio
Surgery