WEEK 1: Ear infections Flashcards
State the parts that make up the external ear.
Outer ear comprises pinna & external auditory meatus (ear canal).
Name the structure that contributes to Otitis externa.
How does it contribute to that? (4 ways)
Ear canal structure contributes to otitis externa
- Cul-de-sac: The ear canal is like a tunnel, with a cul-de-sac-like structure, approximately 2.5cm in length. This shape makes it prone to the accumulation of debris, secretions, and foreign bodies. These materials can get trapped in the canal, leading to irritation and infection.
- Hairs: Hairs present in the ear canal can trap debris, further contributing to the accumulation of material that can harbor bacteria and fungi.
- Structure: The outer ear canal is divided into two parts - the lateral 1/3 overlies cartilage, while the remaining part has a base of bone covered by thin skin. This composition makes the canal susceptible to trauma, as well as providing a suitable environment for microbial growth.
- Prone to moisture: excellent environ. for bacterial & fungal growth
Describe the defense mechanisms of the external ear.
Skin of cartilagenous section contains:
-Sebaceous (lipid-producing) & apocrine (ceruminous) glands
-Hair follicles
(these serve as mechanical barrier against pathogens)
Describe the composition of ear wax (cerumen).
Describe how the ear wax protects the external ear.
Cerumen (earwax): secretions by sebaceous & apocrine glands mixed with desquamated epithelial cells
-Lipid-rich & hydrophobic (repels water)
-Acidic (pH6.8) contains lysozyme - inhibits bacterial & fungal growth
Outline Commensal bacteria of outer ear.
Predominantly Gram+ve bacteria account for 90% of normal flora
i.e.
-Coagulase negative Staphylococci (Gram+ cocci):
S. auricularis, S. epidermidis &S. capitis
-Corynebacterium species (Gram+ve rods)
C. auris, Turicella otitidis
-Streptococci & Enterococci species
-Others include Propionibacterium acnes
Define otitis.
State the 3 types of otitis.
Infection & inflammation of the ear
-Otitis externa
-Otitis media
-Otitis interna or labyrinthitis
What is the other name for otitis externa?
Define otitis externa.
Otitis externa: ‘Swimmers ear’
Otitis externa, also known as swimmer’s ear, is an inflammatory condition of the outer ear canal.
Describe the pathogenesis of acute Otitis externa.
When there’s a break in the skin-cerumen barrier, it disrupts the natural defense mechanisms of the ear canal.
Cerumen (earwax) normally acts as a protective barrier, helping to prevent infection by trapping debris and providing an acidic environment that inhibits bacterial growth.
However, when there’s a break in this barrier, inflammation can occur, leading to symptoms such as pruritus (itchiness), which often prompts scratching, and sometimes even obstruction of the ear canal.
Furthermore, alterations in defense mechanisms such as:
*Changes in the quantity of cerumen
*Impairment of epithelial migration (the movement of skin cells)
*An increase in pH can create a moist, alkaline environment within the ear canal. This environment is conducive to bacterial growth, further exacerbating the inflammation and infection.
Describe the pathogenesis of Chronic Otitis externa.
Persistent low grade inflammation for >3mth.
Generally less painful but profound itching & persistent discharge.
Commonly allergic contact dermatitis e.g. metal earrings, cosmetics, shampoos, hearing devices
Incomplete resolution of an acute infection
Outline the risk factors for otitis externa.
- Mechanical removal of ear wax
- Insertion of foreign objects
*Cotton swabs, matches, Fingernails
*(Hearing aids)
*(Ear plugs) - Trauma to ear canal
- Moisture
- High environmental TC
- Chronic dermatologic diseases
*Eczema
*Psoriasis
*Seborrheic dermatitis
*Acne
Describe the epidemiology and demographics of otitis externa.
Highest in childhood, decreasing in age. Most frequently in children & adolescents, much less in >20yr
May also be associated with warmer seasons; warm & humid climates or water-based activities e.g. outdoor water sports &/ or activities
Causative pathogens of acute otitis externa.
What causes Majority (90%) of cases bacterial? (2)
Majority (90%) of cases bacterial:
-Pseudomonas aeroginosa (30-50%)
-Staphylococcus aureus
Others may include Staphylococcus epidermidis, Corynebacterium & Microbacterium species
Define otomycosis.
Otomycosis: fungal infections of outer ear
How many % of outer ear infections are caused by fungi?
Fungi can also cause outer ear infections approximately 10% cases are fungal.
What is the major contributor to outer ear fungal infections?
These fungal infections, often termed otomycosis, can occur due to various factors, but one significant contributor is the prolonged treatment of bacterial otitis externa.
This prolonged antibiotic treatment can disrupt the normal flora of the ear canal, creating an environment conducive to fungal overgrowth.
Mixed bacterial & fungal infections common.
State the 2 main predisposing factors to fungal outer ear infections.
Predisposing factors: diabetes & immunocompromised state
State the Primary causative pathogens for outer ear fungal infections.
Primary causative pathogens:
- Aspergillus (80-90%cases), followed by Candida species
Aspergillus niger infection has distinctive appearance: i.e. small black conidiophores on white hyphae.
Fluffy, whitish discharge but may be black, gray, bluish-green or yellow
Outline other causes of acute otitis externa.
Acute otitis externa may also be due to:
-Allergic contact dermatitis e.g. from earrings, chemicals in cosmetics
-Contact dermatitis due to prescribed or OTC ototopical antimicrobial agents e.g. neomycin, benzocaine
-Existing dermatologic conditions e.g. psoriasis, atopic dermatitis
-Previous radiation therapy may affect the ear skin & blood supply resulting in ischemic changes, altering cerumen production & so predisposing the ear to infections.
Gram-ve aerobic rod, with polar flagella. Commonly found in the environment e.g. soil, water.
It is not a normal commensal of ear canal. Its identification indicates its presence as a pathogen
Intrinsically/naturally antibiotic resistant, complicating optimal antibiotic therapy
Name the pathogen.
Pseudomonas aeruginosa
People with diabetes have a Predisposition to ear infection with Pseudomonas aeruginosa.
Discuss 2 ways how diabetes is a contributing factor.
Predisposition in diabetics & the elderly
Remember: Diabetes predisposes to microangiopathy in many anatomical sites incl. in ear canal
Increased pH in diabetic cerumen(under normal states pH low), reduces colonisation of commensal bacteria, thus predisposing to pathegens
Discuss the Diagnosis of acute otitis externa.
- Swab may be collected & sent to lab for culture & tests for severe & recurrent cases.
- For mild & moderate cases empiric therapy initiated without request for lab tests
*Otitis externa must be distinguished from suppurative otitis media & hearing assessed. As in both cases, there may be extensive discharge, &/or desquamated epithelium in the canal
-Topical ointments ineffective until debris removed
*Preferable not to irrigate a discharging ear incase of a perforated tympanic membrane
Rather
*Swabbing with cotton tipped applicators or suction to be done to observe tympanic membrane (by ENT specialist)
Describe the diagnostic symptoms for acute otitis externa mild , moderate and severe disease.
*Mild disease is characterized by minor discomfort and pruritus (minimal canal oedema)
*Moderate disease is characterized by an intermediate degree of pain and pruritus, canal may be partially occluded
*Severe disease is characterized by;
- Intense pain.
- Canal is completely occluded by oedema.
- Auricular and/or periauricular cellulitis
- Regional lymphadenopathy
- Fever be present
Describe the management of acute otitis externa.
*Meticulous ear cleaning & application of topical antibiotic therapy or ear drops. A ‘wick’ may be placed to facilitate application of topical agent if there is extensive swelling
*Topical agents must contain broad spectrum antibiotic particularly effective against P. aeruginosa & S. aureus:
- Aminoglycosides:
Aminoglycoside antibiotics, such as neomycin, gentamicin, and tobramycin, are effective against a wide range of bacteria, including many Gram-negative and some Gram-positive bacteria.
They work by inhibiting bacterial protein synthesis.
Aminoglycosides are commonly used in topical ear drop formulations for treating outer ear infections, including cellulitis.
- Chloramphenicol: Chloramphenicol is a broad-spectrum antibiotic effective against a variety of bacteria, both Gram-positive and Gram-negative.
It works by inhibiting bacterial protein synthesis. Chloramphenicol is available in various formulations, including topical preparations for ear infections.
- Fluoroquinolones (e.g., ciprofloxacin):
Fluoroquinolone antibiotics, such as ciprofloxacin, are broad-spectrum antibiotics effective against many Gram-negative and some Gram-positive bacteria.
They work by inhibiting bacterial DNA gyrase, an enzyme essential for bacterial DNA replication.
Fluoroquinolones are available in various formulations, including oral, topical, and intravenous, and they are commonly used for treating ear infections, including cellulitis.
- Corticosteroid, glucocorticoid in combination with an antibiotic e.g. ciprofloxacin, is effective treatment for mild & moderate cases
NB. For severe cases & the immunosuppressed: both topical & systemic antibiotics required, regardless of severity.
Define otitis media.
Otitis media is an inflammatory condition that affects the middle ear.
Otitis media is Frequently in children vs. adults.
Children of what age groups are mostly affected.
Describe structural characteristics that make them prone to the infection.
Frequently in children vs. adults
Extremely more common among children 3 months to 3 years.
WHY?
*Structural differences of eustachian tube (ET) i.e. in children, it’s shorter, narrower, more horizontal & muscles opening tube weaker
More prone to nasopharyngeal secretions being trapped in it & it’s closer to the middle ear.
The trapped secretions may contain viruses or bacteria, which multiply causing infection & inflammation.
Viruses & bacteria can move up the shorter eustachian tube causing middle ear infections
State the risk factors that make children prone to otitis media.
*Increased susceptibility to upper respiratory infections in general
*Immune system still developing
*Increased exposure to infection e.g. nurseries
Middle ear part of an aerated system that incl. nares, eustachian tube & mastoid air cells
So, events affecting one part usu. cause similar changes throughout system
Suppurative infections may spread to adjacent structures may lead to complications.
Describe complications that may occur.
Suppurative infections may spread to adjacent structures may lead to complications i.e.
*Mastoiditis, labyrinthitis, meningitis
What is the significance of the connection of the eustachian tube from the middle ear to the nasal passages?
Why are older children and adult not prone to middle ear infection dur to eustachian tube?
Helps balance air pressure in the middle ear with that in the environment.
In older children & adults, the tube is relatively vertical, wider & more rigid . Secretions passing into it from the nasal passages drain easily
Describe the normal physiological mechanisms of the Eustachian tube in preventing Upper respiratory infections from causing middle ear infections.
Normally, ET Lined with upper respiratory tract-like ‘ciliated’ mucosal epithelium, which keeps mucous in movement from ET to nasopharynx, preventing microbial invasion into middle ear
Mucosal epithelium secretes non-specific defensins e.g. mucus (mucins), lactoferrin, lysozyme & specific immunoglobulins
Dysfunction of eustachian tube can lead to otitis media.
How does it come about?
Dysfunction of ciliary activity results in accumulation of effusion (which may carry viruses & bacteria) in middle ear cavity.
Discuss the characteristics of acute otitis media.
Acute illness characterized by:
*Bulging of the tympanic membrane (distinguishes it from otitis externa)
*Otalgia: Ear pain or discomfort.
*Middle ear fluid
*Inflammation of the middle ear mucosa
May also be associated with ruptured tympanic membrane leading to purulent discharge
Describe the epidemiology and demographics of Acute otitis media.
*3 months to 3 years. Peak age: 6 - 18 months of age.
*60-80% children have at least one episode of AOM by 1yr.
*80-90% by 2-3yr & less common after 7 years of age
Slightly more common in boys vs. girls
Outline risk factors for Acute otitis media.
*1st episode of AOM at <6 mth (may lead to chronic otitis media or OM with effusion)
*Ciliary dysfunction
*Chronic sinusitis
*Attendance in day care
*2nd hand cigarette smoke
*Craniofacial abnormalities such as cleft palate
*Immunocompromising conditions (HIV)
Name the vaccine that have been found to decrease the incidence of AOM.
NB. Immunization of infants with the 7-valent (or 13-valent)
Pneumococcal conjugate vaccine has been shown to decrease the incidence of AOM
Describe the Pathogenesis of otitis media.
Acute otitis media (AOM) primarily a bacterial infection but:
Initially upper respiratory tract infection occurs
Respiratory viruses may act in synergy with bacteria.
Viral inflammation may enhance bacterial invasion from the nasopharynx to the middle ear provoked by sniffing, sneezing & ciliary dysfunction of the eustachian tube
Upper respiratory tract infections may have a substantial impact on bacterial colonization & adherence of the bacteria to the epithelial cells.
Approximately how many % of children (6mth-3yr) - upper respiratory tract infections complicated by otitis media?
Outline the Predominant URI viruses.
61% children (6mth-3yr) - upper respiratory tract infections complicated by otitis media
Predominant viruses:
*Respiratory syncytial virus (RSV);
*Parainfluenza (types 1, 2, 3),
*Influenza (A & B) &
*Adenoviruses
RSV, Adenovirus & coronavirus assoc. with higher rate of AOM
E.g. RSV significantly enhances attachment of Haemophilus influenzae to human respiratory epithelial cells
50% of children with upper respiratory tract infections caused by these viruses develop acute otitis media
Compared to
33% of patients who have upper respiratory tract infections caused by parainfluenza, influenza, enterovirus, or rhinovirus
Describe the pathogenesis of Conjunctivitis-Otitis media syndrome.
The nasolacrimal duct (tear duct) carries tears from the lacrimal sac of the eye into the nasal cavity, which is connected to the Eustachian tube.
So concomitant infection in eye & ear may occur.
NB. Common in pediatric cases
~25% toddlers & infants with bacterial conjunctivitis (~73% of those with purulent conjunctivitis) have concurrent OM
State the common pathogens for Conjunctivitis-Otitis media syndrome.
Describe the treatment plan.
Common pathogens: Streptococcus pneumoniae, Haemophilus influenzae & Moraxella catarrhalis (common upper respiratory infections pathogens)
Treatment: Amoxicillin or Augmentin in cases where an antibiotic taken 30 days prior or failed response to amoxicillin)
State the main Causative pathogens of AOM and percentages.
- Strep pneumoniae (40-50%) COMMON
- Hemophilus influenza (30-40%)
- Moraxella catarrhalis (10-15%)
- Group A streptococcus*
- Staphylococcus aureus* (Rare)
- Anaerobic organisms
- Gram-ve bacilli
- Viruses: Respiratory syncytial virus, adenovirus, rhinovirus, or influenza virus may act in synergy with bacteria
NB. Co infection 40% of children with viral induced acute otitis media
No bacterial pathogen identified in how many % patients with acute otitis media?
No bacterial pathogen identified in 20 - 30% patients with acute otitis media
Common cause of AOM in older children. Frequently associated with perforated tympanic membrane.
Name the pathogen.
Group A streptococcus*
Name the 2 pathogens more in chronic condition of otitis media.
- Staphylococcus aureus*
- Anaerobic organisms
Name the pathogen that causes AOM in Newborns, immunocompromised patients, patients with chronic suppurative otitis media.
Gram-ve bacilli
Severe, recurrent persistent OM & greater clinical severity i.e. high fever, intense otalgia, potential for complications such as bacteremia & mastoiditis
First or early OM episodes
Greater inflammatory response- both elevated peripheral blood & middle ear fluid white blood cell counts compared to other pathogens
Prevalence of penicillin resistant strains varies worldwide but assoc. with children with recurrent &/or persistent AOM
Name the pathogen associated with these.
S. pneumoniae
Discuss Otitis media with effusion /’glue ear’.
Accumulation & effusion of mucoid fluid from middle ear cavity without acute signs of illness or inflammation of the middle ear.
Effusion sterile, often thick resembling liquid glue
Characterized by hearing loss, aural fullness (feeling of fullness or pressure in the ear), & intermittent ear ache
Causes: OME can occur as a result of various factors, including:
*Previous acute otitis media (AOM): OME often follows an episode of acute otitis media, where the fluid persists in the middle ear after the infection resolves.
*Barotrauma: Changes in air pressure, such as during air travel or scuba diving, can cause barotrauma to the middle ear, leading to fluid accumulation.
*Allergies: Allergic reactions or inflammation of the eustachian tube due to allergies can contribute to the development of OME.
Other infections of the middle ear.
Discuss CHRONIC SUPPURATIVE OTITIS MEDIA
***Especially relevant in Botswana: highly prevalent in HIV+ children
Purulent discharge through perforated tympanic membrane, persists >6 weeks despite appropriate treatment
Characterised by hearing loss & drainage for at least 2weeks
Assoc. with perforated tympanic membrane, usually painless or intermittent otorrhea (discharge of fluid or pus from the ear).
Biofilm-producing bacteria also implicated in pathogenesis i.e. Pseudomonas & Proteus spp. Also MRSA, anaerobic bacteria
Outline Causative pathogens of ‘Chronic otitis media’.
-Aerobic
-Anaerobic
Aerobic organisms
*Pseudomonas aeruginosa
*Proteus mirabilis
*S. aureus (MRSA)
*Streptococcus pyogenes
*Escherichia coli
*Klebsiella species
Anaerobic organisms
Bacteroides, Peptostreptococcus or Propionibacterium species
NB. Due to high prevalence & potential to cause serious complications, otitis media is a public health concern.
Discuss Complications of otitis media.
Inner ear infection – otitis interna
Permanent hearing loss / impairment
*Acute mastoiditis
Facial palsy/ paralysis
Discuss Acute mastoiditis: Severe complication of otitis media.
Due to proximity of the middle ear to the mastoid air cells, infection & inflammation of this region may occur during acute otitis media
Suppuration may spread to surrounding bone & extend to brain, causing abscess & meningitis
Occurs any age but more severe in elderly
Although serious, since introduction of antibiotics mastoiditis now rare
Discuss Diagnostic criteria for otitis media.
*Acute otitis media
*Persistent acute otitis media
*Otitis media with effusion
*Chronic otitis media with effusion
*Chronic suppurative otitis media
Acute otitis media
*Acute onset & middle ear effusion, indicated by bulging tympanic membrane, limited or absent mobility of membrane, air-fluid level behind membrane
Symptoms & signs of middle ear inflammation
Erythema of tympanic membrane
Otalgia affecting sleep or normal activity
Persistent acute otitis media
*Persistent features of middle ear infection during antibiotic treatment
or
Relapse within 1month of treatment completion
Otitis media with effusion
*Non-purulent effusion within the middle ear, building up behind the tympanic membrane. Typically asymptomatic
Chronic otitis media with effusion
*Persistent fluid behind intact tympanic membrane in the absence of acute infection
Chronic suppurative otitis media
*Persistent inflammation of the middle ear
Recurrent or persistent otorrhea through a perforated tympanic membrane
Examination tests for otitis media.
- Essential tests: Otoscopy (+ Tympanometry)
- Otoscopy (pneumatic) - examination of the mobility of a tympanic membrane in response to pressure changes
Describe the normal tympanic membrane.
Describe findings which indicate otitis media.
Normal tympanic membrane
-Convex & transluscent
-Mobile moves in response to pressure
Whereas the following indicate otitis media
*Bulging tympanic membrane
*Impaired mobility (may be due to fluid in the middle ear, perforation or tympanosclerosis)
*Distinctly red
Laboratory diagnosis. Collected specimens for Otitis media testing are inoculated onto media that encourages growth of fastiduous microorganisms. These include:
Blood agar
Chocolate agar
Phenylate alcohol agar - selective medium used to cultivate Gram+ bacteria
Anaerobic blood agar
Mackonkey agar - selects for Gram- bacteria
Mycological agar (fungi)
Describe the management of otitis media.
Antibiotics are the mainstay treatment of acute otitis media
But,
Among children, ~19% of pneumococcal & ~50% of H. influenzae A cases resolve without antibacterial drugs
So,
Some countries i.e. extensively in Western Europe, observation of children, rather than initial antimicrobial therapy, is practiced
Management of acute otitis media.
Preferred antibacterial drug must be active against what 3 main pathogens?
Describe the antibiotics given.
Preferred antibacterial drug must be active against
S. pneumoniae,
H. influenzae
M. catarrhalis
Amoxicillin - ‘drug of choice’, limited side effects BUT ineffective against beta-lactamase producing H. influenzae & M. catarrhalis.
Incidence of ampicillin-resistant strains needs to be considered
Alternative regimens include:
Combination of amoxicillin+beta-lactamase inhibitor i.e. clavulanate
2ND generation cephalosporin
In cases of severe allergy to beta-lactam antibiotics, a macrolide (e.g. erythromycin) is the preferred drug
Trimethoprim-sulfamethoxazole may also be used
In cases of a ruptured tympanic membrane
Oral & topical antibiotics administered
Discuss Treatment for Otitis media with effusion
Treatment for Otitis media with effusion
*Majority of effusions resolve ~12 weeks, thus most patients just observed over this period without treatment
In a small percentage of cases, requires surgical intervention by specialist
e.g. Myringotomy with tube placement
Myringotomy: The surgeon makes a small incision in the eardrum (tympanic membrane). This incision allows any fluid or pus trapped in the middle ear to drain out, relieving pressure and improving ventilation.
Tube Placement: After the incision is made, a small tube (tympanostomy tube or ventilation tube) is inserted into the incision in the eardrum. These tubes are typically made of plastic or metal and come in various shapes and sizes. The tubes help maintain ventilation in the middle ear by providing a pathway for air to enter and exit, preventing fluid buildup and reducing the risk of recurrent infections.
Myringotomy, surgical procedure recommended if condition lasts 4 – 6 months e.g. chronic otitis media with effusion
Small incision made in tympanic membrane, insertion of tympanostomy tubes (open at both ends
Tympanostomy tubes in place until they fall out by themselves or removed by a specialist.
Define otitis interna.
What is the other name for otitis interna?
Otitis interna, also known as labyrinthitis, is an inflammatory condition affecting the inner ear.
Outline the 2 major functions of the inner ear.
2 major functions: hearing & balance.
Cochlea involved in hearing function: snail-shaped tube containing fluid & nerve endings transmitting sound signals to brain
Vestibular organs involved in balance function: three loop-shapedsemi-circular canals& sac-shapedutricle & saccule. Relays info. regarding head movement to brain.
Name the nerve that transmits signals to the brain from the inner ear.
Describe its 2 branches.
Vestibulo-cochlear nerve(8th cranial nerve) transmits signals to the brain via 2 branches:
Cochlear nerve transmits messages from hearing organ
Vestibular nerve transmits messages from balance organs.
The brain integrates balance signals from the vestibular nerve from both the right & left ears. So, if there is an infection in one side, signal transmission is affected resulting in dizziness or vertigo.
Define the following infections of the inner ear:
1. Labyrinthitis:
2. Vestibular neuritis
Labyrinthitis: inflammation of the labyrinth
Vestibular neuritis inflammation of the vestibulocochlear nerve
Outline characteristics of inner ear infections
Characterised by:
Rapid onset of severe vertigo, nausea, vomiting, gait instability & may affect hearing to varying degrees (unilateral or bilateral)
Most common in adults aged 30-60yr
rarely in children
Discuss the etiology of Vestibular neuritis & labyrinthitis: inner ear infections.
Etiology
- Vestibular neuritis & labyrinthitis usually due to viral infections less commonly bacterial
Often resulting from systemic viral infections i.e. herpes, chickenpox, shingles.
- Bacterial labyrinthitis maybe a complication of an untreated middle ear infection (suppurative labyrinthitis) or meningitis
Most cases are uncomplicated with complete resolution but some ~15% result in persistent symptoms at 1yr. Recurrence is rare i.e. ~2 - 11% of cases
Describe the pathogenesis of inner ear infection.
*Bacterial
*Viral
Although symptoms of bacterial and viral infections may be similar, the treatments are different, so specific diagnosis is essential.
Bacterial
Severe bacterial labyrinthitis may also involve middle infections and the surrounding bone.
The bacterial infection initiates either in the middle ear or in the cerebrospinal fluid, as a result of bacterial meningitis.
Bacteria can access the inner ear through the cochlear aqueduct, the auditory canal, or a fistula in the horizontal semi-circular canal.
Viral
Although viral infections of the inner ear are more common than bacterial infections, less is known.
Viral inner ear infections may result from an initial systemic viral illness (e.g. chicken pox, measles). Or, the infection may be confined to the labyrinth &/ or the vestibulo-cochlear nerve.
Virus etiology of vestibular neuritis or labyrinthitis: herpes simplex viruses, varicella-zostervirus & other viruses that cause influenza, measles, rubella, mumps, polio, hepatitis & Epstein-Barr. NB.
Other viruses may also cause viral inner ear infections however due to difficulties in sampling the labyrinth without destroying it, the full etiology is still unknown.
Also viral inner ear infections may be go into ‘latency’ i.e. seemingly asymptomatic, but being dormant in the nerve and flaring up at intervals.
Discuss the management of inner ear infections.
-During the acute phase
Primarily a clinical diagnosis, to differentiate from cerebrovascular syndromes, that may have similar symptoms. Management is largely ‘supportive’, alleviating to symptoms:
During the acute phase
*Anti emetics; anti histamines; benzodiazepines recommended
Benzodiazepines are a group of CNS depressants which induce feelings of calm (anxiolysis), drowsiness and sleep.
They act by facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS.
They may be prescribed to help relieve symptoms of anxiety and agitation commonly associated with severe vertigo.
NB. efficacy of corticosteroids remains controversial & these not recommended in some regions
Similarly the efficacy & prescription of anti viral medications (used alone or in combination with a glucocorticoid) is debatable
Discuss the management of inner ear infections.
-After the acute phase
Vestibular rehabilitation therapy recommended to & improve :
*Gaze & postural stability
*Improve vertigo
*Improve daily living activities
With treatment infections may resolve within few wks but if inner ear permanently damaged:
*Chronic dizziness, fatigue, disorientation, tinnitus, hearing loss may persist
