Otitis Externa Flashcards
What 3 tissues is the auricle (pinna) earlobe made of?
- cartilage
- perichondrium
- thin vascularized skin
What are the two sections is the external auditory meatus/ear?
- outer: hair, sebaceous and ceruminous glands
2. inner: rigid bone
What is the Isthmus?
narrowing of the canal
What are 3 characteristics of cerumen?
- acidic pH: protects against infection
- hydrophobic: protects skin of external ear canal from water damage
- self-cleaning: epidermal cells migrate to outside by jaw movement
What are signs of impacted cerumen?
fullness, hearing loss, tinnitus itchiness NO PAIN
Risk factors for impacted cerumen?
anatomy of the ear overproduction of cerumen migration failure foreign objects in the ear prior history of impaction older age
How to treat impacted cerumen?
only for symptomatic pts
Cerumenolytics
- oil based wax softeners (olive oil, light mineral oil, almond hair) used 4days per week for 2-3 weeks
- water based wax softeners (water, saline, hydrogen peroxide)
Professional removal
- irrigation
- manual removal
When to refer patient when they have impacted cerumen?
rash in-ear or ear infection
history of ear surgery or tubes in the ear
foreign object in the ear
the suspected burst eardrum
(bleeding/discharge, dizziness, pain, ringing sound, hearing loss)
What is otitis externa known as?
“Swimmers ear”
inflammation of the external ear canal
otitis externa
What is considered acute OE
what is considered chronic OE
acute < 3 weeks
chronic > 3 weeks
What bacteria causes acute OE
Pseudomonas
S. aureus
klebsiella, proteus
what organism causes chronic chronic OE?
caused by fungi or allergies
otomycosis
aspergillus
candida albicans
List some risk factors for otitis externa
long time in the water and pH goes up high temperature no ear wax trauma using foreign objects dermatology conditions age (7-12)
Symptoms of otitis externa
pain *within 48 hours) itching ear fullness headache discharge swollen ear canal loss of hearing
When diagnosing otitis externa, what four things can you rule out?
acute otitis media
malignant otitis externa
dermatological conditions of the ear
sensitization from otic medications
When to refer to physician for otitis externa?
fever, malaise,
bleeding/discharge
progressing ear pain, stabbing pain, hearing loss
Goals of therapy
eliminate pathogen organisms
control/relieve pain and otorrhea
restore ear canal to normal health, normal pH and adequate cerumen
Non pharm treatment options for patient with otitis externa
keep the ear dry and avoid water in the ear for 7-10 days
clean ear canal
analgesic treatment
Pharmacolgical treatment for otitis externa
- acidifying agents
- topical antibiotics
Systemic therapy only for severe cases
What is the function of acidifying agents in otitis externa?
produce low pH
use vinegar: water
dilute it 50% with water and can be used as prophylaxis
List some antibacterial OTC agents
polysporin
polysporin + pain relief
Antibacterial agents Rx
fluoroquinolones
aminoglycosides
combinations (ciprodex)
List 5 drug families that are known to cause ototoxicity
aminoglycosides other antibiotics (erythromycin, tetracycline)
Usually reversible but cause ototoxicty
chemotherapeutic agents
salicylates
antimalarials
