Flashcards in Acute otitis externa Deck (12):
What are the risk factors for acute OE?
3. foreign body in the ear
4. using a hearing aid
5. certain dermatological conditions
6. chronic otorrhea
7. wearing tight head scarves
9. ear piercing --> infection of the pinna
How do you diagnose acute otitis externa?
1. rapid onset (generally within 48h) in the past 3 weeks
2. symptoms of ear canal inflammation including:
- otalgia, itching, or fullness
- WITH or WITHOUT hearing loss or jaw pain
3. signs of ear canal inflammation, including:
- tenderness of the tragus, pinna or both
- diffuse ear canal edema, erythema, or both
- WITH or WITHOUT otorrhea, regional lymphadenitis, tympanic membrane erythema or cellulitis of the pinna and adjacent skin
What organisms cause AOE?
1. Pseudomonas aeruginosa
2. Staphylococcus aureus
4. Gram negative bacteria
5. Rare fungal infections w/ Aspergillus or Candida species
What is the treatment for mild-to-moderate AOM?
1. Topical antibiotics w/ or w/out topical steroids x 7-10d
2. Adequate pain control w/ acetaminophen, NSAID, or opioid
3. Aural toileting and wick therapy to facilitate topical medication delivery and decrease canal edema
What is the treatment for severe AOE?
Systemic antibiotics that cover S. aureus and P. aeruginosa
When should clinical response occur?
Within 48-72h but full response can take up to 6d
What should non-response prompt evaluation for?
2. presence of foreign body
3. non-adherence to therapy
4. alternative diagnosis i.e. viral, fungal, dermatitis
What is malignant OE?
Invasive infection of the cartilage and bone of the canal and external ear which may present w/ facial nerve palsy and pain
Who is at risk of malignant OE?
Patients w/ insulin-dependent diabetes
What is the management of malignant OE?
1. CT or MRI to confirm
2. Aggressive debridement
3. Systemic antibiotics targeted at P. aeruginosa and possibly Aspergillus
How do you prevent AOE?
1. Insert soft malleable plug to prevent water in canal
2. remove water from the ears after swimming via positioning and shaking head
3. daily prophylaxis w/ alcohol or acidic drops during at risk activities not studied
4. avoid hard earplugs