EAR PAIN Flashcards
(28 cards)
What is otalgia?
Ear pain
What are the 2 types of otalgia?
Primary otalgia - coming directly from ear
Secondary otalgia - referred pain from somewhere outside the ear
What are causes of primary otalgia?
Acute otitis media - most common cause in children <2
Otitis externa
Necrotising otitis externa
Eustachian tube dysfunction
FB
Trauma
Impacted ear wax
Otalgic neoplasms
What are causes of secondary otalgia?
Dental inflammation or infection
TMJ disorders
Trigeminal neuralgia
Head and neck cancer
Temporal arteritis
What is otitis externa?
Diffuse inflammation of the skin and subdermis of the auditory canal which may also involve the pinna or tympanic membrane
What is otitis externa commonly known as?
Swimmers ear
Tropical ear
What is acute and what is chronic otitis externa?
Acute - <6 weeks duration
Chronic - >3 months
What typically causes acute otitis externa?
Bacterial infection with staph aureus or pseudomonas aeruginosa
What typically causes chronic otitis externa?
Fungal infection e.g. Candida albicans or aspergillus species
What is malignant otitis externa?
Aka necrotising otitis externa
A potentially life-threatening progressive infection of the external ear canal which may spread to cause osteomyelitis of the temporal bone and adjacent structures
What commonly causes malignant otitis externa?
Pseudomonas aeruginosa
Risk factors for acute otitis externa?
Skin conditions e.g. eczema, psoriasis and seb derm
Acute otitis media
Contact dermatitis e.g. shampoos
Trauma to ear canal e.g. from cleaning
FB in ear
Water exposure
Ear canal obstruction e.g. debris or excess wax production
Risk factors for chronic otitis externa?
Skin conditions e.g. eczema, psoriasis
Uncontrolled DM or other causes of immunocompromise
Contact dermatitis e.g. shampoo, nickel earrings
Fungal infections after topical antibiotics or corticosteroid use
What can cause malignant otitis externa?
Uncontrolled diabetes or other cases of immunocompromise
Older age
Radiotherapy to head, ear or neck which may damage the ear
Previous ear surgery or ear irrigation
Possible complications of otitis externa?
Chronic otitis externa
Regional spread of infection e.g. cellulitis
Fibrosis and stenosis of ear canal or fibrosis of TM -> conductive hearing loss
Myringitis and perforation of TM
Malignant otitis externa
Prognosis of malignant otitis externa
Life threatening
Temporal bone osteomyelitis is associated with a mortality rate of 10-21%
How does acute otitis externa present?
Rapid onset within 48 hours of:
Itchy ear canal
Ear pain and tenderness of tragus or pinna with possible jaw pain
Ear discharge
Hearing loss due to ear canal occlusion - less common
In young children - crying, poor feeding, restlessness at night, cough, rhinorrhoea, rubbing of ear
Signs of acute otitis externa?
Tenderness of the tragus and/or pinna.
The ear canal is red and oedematous, and there may be debris and ear discharge contributing to swelling and canal occlusion.
Tympanic membrane erythema (may be difficult to visualize if the ear canal is narrowed or filled with debris).
Cellulitis of the pinna and adjacent skin.
Conductive hearing loss (less common).
Tender regional lymphadenitis (less common).
Symptoms and signs of chronic otitis externa?
Constant itch in the ear.
Mild discomfort or pain (rare).
Lack of ear wax in the external ear canal.
Dry scaly skin in the ear canal, which varies in thickness but often results in at least partial canal stenosis; or red, moist skin in the ear canal.
Fluffy, cotton-like debris, hyphae, or dots of black debris may be seen in the ear canal if there is fungal infection.
Conductive hearing loss.
Symptoms of malignant otitis externa?
Unremitting disproportionate ear pain, headache, purulent otorrhoea, fever, or malaise.
Vertigo.
Profound conductive hearing loss.
Ipsilateral facial nerve palsy
Signs of malignant otitis externa?
Systemically unwell, high fever.
Granulation tissue seen on the floor of the ear canal and at the bone-cartilage junction; exposed bone in the ear canal.
Ipsilateral facial nerve palsy.
Management of otitis externa?
topical antibiotic or a combined topical antibiotic with a steroid
if the tympanic membrane is perforated aminoglycosides are traditionally not used
if there is canal debris then consider removal
if the canal is extensively swollen then an ear wick is sometimes inserted
What % of cases of maligannt otitis externa are in diabetics?
90%
How is maligannt otitis externa diagnosed?
CT scan is typically done
