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ENT > ENT - Otitis Media, Glue Ear, Otitis Externa > Flashcards

ENT - Otitis Media, Glue Ear, Otitis Externa Flashcards

1
Q

Otitis Media (OM) - what is it?

A

Otitis media is the name given to an infection in the middle ear

Bacteria enter from the back of the throat through the eustachian tube

Viral upper respiratory tract infection often precedes bacterial infection of the middle ear.

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2
Q

OM - anatomy of where middle and inner ear are located

A

The middle ear is the space that sits between the tympanic membrane (eardrum) and the inner ear

This is where the cochlea, vestibular apparatus and nerves are found

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3
Q

OM - what are the most common causative organisms?

A

The most common bacterial cause of otitis media is streptococcus pneumoniae

(causes other ENT infections such as rhino-sinusitis and tonsillitis)

Other common causes include:

Haemophilus influenzae

Moraxella catarrhalis

Staphylococcus aureus

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4
Q

OM - clinical features?

A

Acute onset of symptoms

  • otalgia - primary feature in adults
  • fever - 50% of cases
  • hearing loss
  • recent viral URTI symptoms are common
  • ear discharge - if tympanic membrane perforates
  • Children may tug or rub their ear
  • When the infection affects the vestibular system, it can cause balance issues and vertigo
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5
Q

OM - features you may find on otoscopy?

A

bulging tympanic membrane → loss of light reflex

perforation with purulent otorrhoea

opacification or erythema of tympanic membrane

decreased mobility if using a pneumatic otoscope

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6
Q

OM - management?

A

Self-limiting condition - does not require an antibiotic prescription

Analgesia for otalgia

If hasn’t improved in 3 days, seek medical help

Antibiotics should be prescribed immediately if:

  • Symptoms lasting more than 4 days or not improving
  • Systemically unwell but not requiring admission
  • Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
  • Younger than 2 years with bilateral otitis media
  • Otitis media with perforation and/or discharge in the canal

1st line, antibiotic: 5-7 day amoxicillin

Penicillin allergy - erythromycin or clarithromycin

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7
Q

OM - complications?

A
  • Otitis media with effusion
  • Hearing loss (usually temporary)
  • Perforated tympanic membrane (with pain, reduced hearing and discharge)
  • Labyrinthitis (causing dizziness or vertigo)
  • Mastoiditis (rare)
  • Abscess (rare)
  • Facial nerve palsy (rare)
    • Meningitis (rare)
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8
Q

Glue Ear - what is it?

A

Glue ear describes otitis media with an effusion (other terms include serous otitis media)

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9
Q

Glue Ear - what is it?

A

Glue ear describes otitis media with an effusion (other terms include serous otitis media)

It is common with the majority of children having at least one episode during childhood

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10
Q

Glue ear - risk factors?

A
  • male sex
  • siblings with glue ear
  • higher incidence in Winter and Spring
  • bottle feeding
  • day care attendance
  • parental smoking
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11
Q

Glue ear - features?

A
  • peaks at 2 years of age
  • hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)
    • secondary problems such as speech and language delay, behavioural or balance problems may also be seen
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12
Q

Glue ear - management?

A

Grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube, the majority stop functioning after about 10 months

Adenoidectomy

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13
Q

Otitis Externa (OE) - what is it?

A

Otitis externa is inflammation of the skin in the external ear canal. Oto- refers to ear, -itis refers to inflammation, and externa refers to the external ear canal

It can spread to the external ear (pinna)

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14
Q

OE - what are the two types of infection?

A

Localised

Diffuse

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15
Q

OE - is it acute, chronic, or both?

A

It can be acute (less than three weeks) or chronic (more than three weeks)

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16
Q

OE - what is another name?

A

Otitis externa is sometimes called “swimmers ear”, as exposure to water whilst swimming can lead to inflammation in the ear canal

17
Q

OE - what are some causes?

A
  • Bacterial infection
  • Fungal infection (e.g., aspergillus or candida)
  • Eczema
  • Seborrhoeic dermatitis
    • Contact dermatitis
18
Q

OE - what are the two most common bacterial causes?

A
  • Pseudomonas aeruginosa - gram-negative aerobic rod-shaped bacteria
    • Staphylococcus aureus
19
Q

OE - symptoms?

A
  • Ear pain
  • Discharge
  • Itchiness
    • Conductive hearing loss (if the ear becomes blocked)
20
Q

OE - clinical features seen on examination?

A

Erythema and swelling in the ear canal

Tenderness of the ear canal

Pus or discharge in the ear canal

Lymphadenopathy (swollen lymph nodes) in the neck or around the ear

The tympanic membrane may be obstructed by wax or discharge. It may be red if the otitis externa extends to the tympanic membrane. If it is ruptured, the discharge in the ear canal might be from otitis media rather than otitis externa

21
Q

OE - how do you diagnose?

A

Diagnosis can be made clinically otoscopy

An ear swab can be used to identify the causative organism but is not usually required

22
Q

OE - how do you treat mild, moderate, and severe OE?

A

Mild:

  • Acetic acid 2% (EarCalm)
  • Acetic acid has an antifungal and antibacterial effect
  • Used prophylactically before and after swimming in patients that are prone to otitis externa

Moderate:

  • usually treated with a topical antibiotic and steroid, for example:
  • Neomycin, dexamethasone and acetic acid (e.g., Otomize spray)
  • Gentamicin and hydrocortisone
  • Ciprofloxacin and dexamethasone
  • So either a quinolone of aminoglycoside antibiotic
  • if tympanic membrane perforated, aminoglycosides not used, so need to exclude this - ototoxicity risk

Severe:

  • Severe or systemic symptoms may need oral antibiotics (e.g. flucloxacillin or clarithromycin)
23
Q

OE - what are other treatment options?

A
  • Canal debris removal
  • If the canal is extensively swollen then an ear wick is sometimes inserted - made of sponge or gauze, they contain topical treatment for otitis externa (antibiotics and steroids), they are inserted into canal and left for period of time
    • Fungal infections can be treated with clotrimazole ear drops
24
Q

OE - malignant OE, what is it?

A

Malignant otitis externa is a severe and potentially life-threatening form of otitis externa

The infection spreads to the bones surrounding the ear canal and skull

It progresses to osteomyelitis of the temporal bone of the skull

25
Q

OE - malignant OE, most commonly causing organism?

A

Pseudomonas aeruginosa

26
Q

OE - malignant OE, who does it commonly affect?

A

Elderly diabetics

Immunosuppressant medications (e.g., chemotherapy)

HIV

27
Q

OE - malignant OE, symptoms, and key finding that indicates malignant otitis externa?

A

Symptoms - more severe than otitis externa, persistent headache, severe pain and fever

Granulation tissue at the junction between the bone and cartilage in the ear canal (about halfway along) is a key finding that indicates malignant otitis externa

28
Q

OE - malignant OE, management?

A

Emergency management:

  • Admission to hospital under the ENT team
  • IV antibiotics - ciprofloxacin, as most effective against most commonly causing organism, Pseudomonas
  • Imaging (e.g., CT or MRI head) to assess the extent of the infection
29
Q

OE - malignant OE, complications?

A
  • Facial nerve damage and palsy
  • Other cranial nerve involvement (e.g., glossopharyngeal, vagus or accessory nerves)
  • Meningitis
  • Intracranial thrombosis
  • Death

ENT (8 decks)

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