ENT: Otalgia

Question 1

What proportion of otalgia is due to referred pain?

Answer 1

Approx. 50%

Question 2

What makes up the outer ear?

Answer 2

Pinna
Ear canal
Ear drum

Question 3

What makes up the middle ear?

Answer 3

Oscicles

Unlikely to have an abnormal middle ear with normal drum

Question 4

What makes up the inner ear?

Answer 4

Vestibulocochlear apparatus

Insensive

Question 5

What are the otological (non referred) causes of ear pain?

Answer 5

Acute otitis media
Otitis externa
Furuncule
Necrotising otitis externa

Question 6

What are the refered causes of otological pain?

Answer 6

Dental pathology
TMJ (temperomandibular joint) dysfunction
Osteoarthritis of the cervical spine
Malignancy of pharynx and larynx
Acute infection of pharynx

Question 7

When would you consider refered pain?

Answer 7

In presence of normal ear exam.

Question 8

What are red flags for oropharyngeal malignancy with otalgia?

Answer 8

Dysphagia
Hoarseness
Dysphonia

Question 9

What is otitis externa?

Answer 9

Infection of the outer ear (aka Swimmer’s ear)

Question 10

What are the symptoms of otitis externa?

Answer 10

Painful discharging ear

Question 11

What are the risk factors of otitis externa?

Answer 11

Eczema/dermatitis

Question 12

What are the common causative organisms of otitis externa?

Answer 12

Pseudomonas

Fungal infection

Question 13

How is otitis externa diagnosed?

Answer 13

Ear examination
Debris in ear
Oedema or stenosis of ear canal

Question 14

What differs in fungal otitis externa?

Answer 14

Visible fungus or black debris in ear.

Question 15

What is the treatment of bacterial otitis externa?

Answer 15

Topical antibiotics (1st line)
Gentamycin/Ciprofloxacin
Oral is less recommended, won’t reach the debris.

Microsuction
Insertion of pope wick
Water precautions

Question 16

What is the treatment of fungal otitis externa?

Answer 16

Clotrimazole 1% topical for at least 14 days.

Question 17

How can you prevent otitis externa?

Answer 17

Keep ears dry - pool guards
Don’t use ear buds
Acetic acid

Question 18

What is a furuncle?

Answer 18

Staphylococcal abcess on a hair follicle.

Question 19

What are the symptoms of a furuncle?

Answer 19

Exquisitely tender

Dry ear - not otitis externa

Question 20

What is the treatment of a furuncle?

Answer 20

Incision and drainage
Flucloxacillin
Wick insertion

Question 21

What is necrotising (malignant) otitis externa?

Answer 21

Potentially fatal osteomyelitis of the EAM and bony tympanic plate.

Question 22

How can necrotising (malignant) otitis externa be fatal?

Answer 22

Can spread along the inferior surface of the skull base, complications include meningitis, cerebral abscess and dural sinus thrombosis.

Question 23

Who is more at risk of necrotising (malignant) otitis externa?

Answer 23

Elderly diabetic patients

Question 24

What is the typical causative organism of necrotising (malignant) otitis externa?

Answer 24

Psudomonas aeruginosa

Question 25

What is the presentation of necrotising (malignant) otitis externa?

Answer 25

Severe, unremitting otalgia Purulent aural discharge Granulations at the isthmus (bone-cartilage junction) of EAM. Single or multiple cranial neuropathies may also occur, usually VII.

Question 26

What is acute otitis media?

Answer 26

Infection of the middle ear

Question 27

Who does acute otitis media occur in?

Answer 27

Mainly children

Question 28

What are the common causative organisms of acute otitis media?

Answer 28

RSV Rhinovirus Parainfluence Streptococcus pneumonie Haemophillus influenxe Moracella catarrhailis

Question 29

What are the signs and symptoms of acute otitis media?

Answer 29

Inflammation of the middle ear Bulging tympanic membrane Rapid onset ear ache Rubbing and tugging of the ear Systemic signs: fever, irritability, poor sleep Preceding URTI symptoms: cough, rhinorrhea.

Question 30

What is the treatment of acute otitis media?

Answer 30

Largely self limiting Usually viral resolving in 48-72 hours. ``` Antibiotics if: Increasingly unwell Decreased PO intake Increasing pain No improvement in 72 hours Developing complications ``` Role for delayed Abx presentation (5 day course)

Question 31

What is the treatment for recurrent acute otitis media?

Answer 31

Grommet insertion

Question 32

What are the complications of acute otitis media?

Answer 32

``` Mastoiditis Tympanic membrane perforation (chronic) Rare: Meningitis Abscesses Nerve palsy Hearing loss ```