Primer On Ear Infections

Question 1

Itching progressing to otalgia
Scant white exudative otorrhea 
Edema
Erythema
Tenderness 
Aural fullness
Temp hearing loss
Tinnitus 
Tympanic membrane moves well 
Kids aren't ear tugging

Answer 1

Otitis Externa

Question 2

MCC of Otitis Externa

Answer 2

Pseudomonas
S. epidermidis
S. aureus
Candida albicans
Aspergillus
Anaerobes

Question 3

Purulent ear discharge
Erythema
Edema
Granulation tissue in posterior inferior wall of external canal
Severe unrelenting pain
Temporal headaches
Bell's palsy, partial facial paralysis, usually one sided, CNVII involvement
Erosion of temporal bone on CT
Elderly diabetics
IC

Answer 3

Malignant Otitis Externa

Question 4

MCC of malignant Otitis Externa

Answer 4

Pseudomonas aeruginosa

Question 5

Abrupt onset
Otorrhea with purulent white to yellow discharge
Otalgia
Aural fullness
Vertigo
Tinnitus
Fever
Nystagmus
Ear tugging 
Infants can have vomiting and diarrhea
Abnormal tympanic membrane

Answer 5

Acute Otitis media

Question 6

MCC of acute Otitis media (includes recurrent Otitis media and chronic suppurative Otitis media)

Answer 6

S. pneumoniae
H. influenzae
M. catarrhalis

Usually preceded by viral URI

Question 7

MCC of acute Otitis media in infants <6 weeks old and those with nasotracheal tubes in place for more than 48 hours

Answer 7

Gram negatives like 
Klebsiella
E. coli
Enterobacter
Pseudomonas

Question 8

Clear fluid in the middle ear for an extended period
No Fever or leukocytosis
Self limiting
Resolved in 2-4 weeks

Answer 8

Otitis media with effusion

Question 9

MCC of Otitis media with effusion

Answer 9

Effusions may be sterile

Question 10

Persistent (weeks) purulent otorrhea
Tympanic membrane perforation
Some hearing loss
Maybe cholesteatoma (mass of keratinous devris)

Answer 10

Chronic suppurative Otitis media

Question 11

Redness, swelling, tenderness, and fluctuation over the mastoid process
Pinna is displaced laterally and inferiorly by the abscess
Exacerbations of aural pain, Fever, and creamy otorrhea
Persistent and throbbing pain
Babies may refuse to feed
Bulging and immobility in tympanic membrane
May have Bell’s palsy

Answer 11

Mastoiditis

Question 12

MCC of mastoiditis

Answer 12

Same as Otitis media
When severe or protracted think of 
S. pyogenes
S. aureus
P. aeruginosa