S19C237 - Common disorders of the external, middle and inner ear

Question 1

Otitis Externa: symptoms and organisms

Answer 1

• erythema/edema of ext auditory canal
• pain, pain with chewing, purulent otorrhea, decreased hearing
• RF: swimming, hot tubs, lakes, humid climate, trauma/abrasion
• organisms: pseudomonas, enterobacteriaceae, proteus, staph, p. aeruginosa, fungal

Question 2

Otitis externa: Tx

Answer 2

• analgesia
• acidifying agents
• topical Abx: cipro or ofloxacin
• ofloxacin is approved for peds and for ruptured TM
• steroids
• cleansing - hydrogen peroxide

Question 3

Malignant Otitis Externa

Answer 3

• life-threatening
• involves pinna and soft tissues and can extend to skull
• > 90% caused by p. aeruginosa
• may involve mastoid air cells, sigmoid sinus, parotid gland, ckull base, 7th CN, 10th, 11th
• suspect in pts with 2-3w hx of treated otitis externa (Faster onset in kids)
• otalgia and edema of external auditory canal +/- otorrhea
• may have POOP
• complications: sinus thrombosis, meningitis
• dx: CT

Question 4

Malignant Otitis Externa: Tx

Answer 4

• imipenem for children

- cephalosporin + quinolone for adult

Question 5

Otitis media

Answer 5

-prevalence peaks in preschool children
-70% are viral
-bacteria: strep pn, h flu, moraxella catarrhalis
(different h flu than what is vaccinated for)
-chronic OM pathogens: s aureus, p aeruginosa, anaerobes
-Sx: otalgia, +/-fever, hearing loss, otorrhea, tinnitus, vertigo
retracted/bulging TM, red/yellow/white, impaired mobility

Question 6

OM: Tx

Answer 6

• if >2yo and afebrle w/o severe Sx, analgesics only x48h
• if severe, or Sx persist for >48h then tx with amoxicillin high dose
  adults: 500-875mg q12h or 500mg TID x7-10d
• other agents: Septra, azithro, cefuroxime, amox-clav
• OM with effusion: Abx ,3w, consider adding prednisone

Question 7

OM: complications

Answer 7

• TM perforation, heals in 1w or chronic perforation may occur
• conductive hearing loss, should resolve
• facial nerve paralysis
• mastoiditis (tx with vanco)
• meningitis
• lateral sinus thrombosis

Question 8

Cholesteatoma

Answer 8

• collections of epidermis and exfoliated keratin w/in middle ear/mastoid
• as it expands it erodesinto the ossicular chain, bony labyrinth or facial nerve canal
• intracranial extensions can be life-threatening

Question 9

Lateral sinus thrombosis

Answer 9

• complications of AOM
• from reactive thrombophlebitis with mural clot formation, intraluminal empyema, preforation of venous wall
• h/a, papilledema, 6th CN palsy
• Dx: CTA
• Abx: IV pcn, CTX and flagyl

Question 10

Bullous myringitis

Answer 10

• bulla formation on TM and deep external auditory canal
• severe otalgia
• blisters may be serous or serosang
• may have middle ear effusion
• brief otorrhea if bullae rupture
• etiology: Mycoplasma pneumoniae, chlamydia psittaci
• tx: analgesia, Abx optional

Question 11

Frostbite on ear

Answer 11

-warm, do not pop blisters, analgesia

Question 12

Burns of ear

Answer 12

-refer if substantial 2nd degree burns with blistering or any 3rd deg burn

Question 13

Auricular hematoma

Answer 13

-drain and apply a pressure dressing to prevent re-accumulation and cauliflower ear

Question 14

Foreign body in ear

Answer 14

• if alive, drown it in 2% lidocaine to paralyze it and provide topical anesthesia
• suction fluid and insect out
• small particles - irrigation (sand)