otitis media + externa Flashcards
(26 cards)
commonest causative organisms of otitis media
- strep pneumoniae
haemophilus influenzae
moraxella catarrhalis
otitis media features
otalgia - tug/rub their ear
fever in 50%
hearing loss
recent URTI !
ear discharge if tympanic membrane perforated
otoscopy findings in otitis media
bulging tympanic membrane -> loss of light reflex
opacification / erythema of membrane
perforation - purulent otorrhoea
criteria for diagnosis of otitis media
- acute onset of sx
- presence of middle ear effusion
- bulging membrane
- otorrhoea
- decreased mobility on pneumatic otoscopy - inflammation of tympanic membrane
- erythema
management of otitis media
self-limiting, no Abx
- (some exceptions)
analgesia
!! seek medical advice if sx worsen or do not improve after 3days
exceptions where antibiotics should be prescribed immediately in otitis media
- sx lasting >4days + not improving
- systemically unwell but not requiring admission
- immunocompromised or high risk
- <2yrs with bilateral otitis media
- otitis media with perforation +/- discharge in canal
antibiotics given in otitis media
5-7day course of amoxicillin
pen allerg = erythromycin, clarithromycin
complications of otitis media
mastoiditis !!
meningitis
brain abscess
facial nerve paralysis
what might unresolved otitis media with perforation develop into
chronic suppurative otitis media (CSOM)
CSOM = perforation of tympanic membrane with otorrhoea >6weeks
- hearing loss
- labyrinthitis
features of mastoidiris
otalgia - severe, BEHIND ear
hx of recurrent otitis media
fever
swelling, tenderness of mastoid
ear may protrude forwards
diagnosis of mastoiditis
typicall clinical, CT may be ordered if complications suspected
management of mastoiditis
IV antibiotics
complications of mastoiditis
facial nerve palsy
hearing loss
meningtitis
risk factors for otitis media with effusion (glue ear)
males
siblings with glue ear
commoner in winter + spring
bottle feeding
day care attendance
parental smoking
features of otitis media with effusion (glue ear)
peaks at 2years
!!! bilateral -> unilateral = concerning
presenting feature usually –> hearing loss (conductive)
secondary problems
- speech + language delay
- behavioural or balance
management of otits media with effusion (glue ear)
1st presentation = active observation
- observe for 3months
grommet insertion
- most stop functioning after 10months
adenoidectomy
malignant otitis externa
otitis externa found in IMMUNOCOMPROMISED
- 90% in diabetics !!!
can progress to temporal bone osteomyelitis
common causative organism in malignant otitis externa
pseudomonas aeruginosa
malignant otitis externa presentation
diabetic / immunosupp
severe, unrelenting, deep otalgia
temporal headaches
purulent otorrhea
possible dysphagia, hoarseness, and or facial nerve probs
diagnosis + management of malignant otitis externa
dx = CT
mx
- non-resolving otitis externa with worsening pain = refer urgently to ENT
- IV antibiotics that cover pseudomonal infections
–> ciprofloxacin
causes of otitis externa
infection
seborrhoeic dermatitis
contact dermatitis
recent swimming
otitis externa presentation + otoscopy findings
ear pain, itch, discharge
otoscopy;
- red, swollen, eczematous canal
management of otitis externa
1st = topical antibiotic or combined antibiotic with steroid
2nd = antifungal agent
infection spreading = oral fluclox
management of glue ear with a background of Down’s syndrome or cleft palate
refer to ENT
