URT conditions and infections III Flashcards
What is diffuse otitis externa
An infection of the ear
canal, often due to Gram negative bacilli (especially P. aeruginosa).
Pain is increased when chewing and
the lining of the canal may be either
inflamed or swollen with dry or
moist debris or even a white or
clear discharge.
Describe furuncular otitis externa
Usually caused by
Staphylococcus aureus. A painful
localised swelling present at the
entrance to the ear canal.
* May be precipitated by trauma
caused by scratching, e.g.
matchsticks, earbuds
State 5 general measures for otitis externa
Exclude any underlying suppurative otitis media (middle ear
infection).
* Most cases recover after thorough cleansing and drying of the ear.
* Keep the ear clean and dry (dry mopping).
* Do not leave pieces of cotton wool, etc. in the ear.
* Do not instil anything into the ear unless prescribed
Medical Tx for diffuse otitis externa
First Dry wicking the ear with gauze or absorbant cloth, and then use acetic acid 2% in alcohol (topical). 3-4 drops every 6 hours for 5 days.
No antibiotic required
Medical tx for furuncular otitis externa
Cefalexin, oral for 5 days, or flucloxacillin oral for 5 days.
If pt has severe penicillin allergy, then give Azithromycin, oral for 3 days
What is otitis media? give its 6 characteristics
Otitis media is inflammation of the middle ear. It is characterised by:
Pain, perforation of the eardrum, red, bulging eardrum, loss of light reflex of eardrum, loss of hearing, fever in 50% of the cases
state the 5 general measures for acute otitis media
-Do not instil anything into the ear
-Do not put any fluids into the ear
-Do not plug with cotton wool etc
exclude HIV as the cause of recurrent infections
Dry mop the ear if there is discharge
Medical tx for acute otitis media
Amoxicillin, po, 12 hourly for 5 days
For those who have taken antibiotic
treatment in the last 30 days:
* Co-amoxiclav 12 hourly for 5 to 10
days
Severe penicillin allergy:
* Azithromycin, po, daily for 3 days
Pain and congestion management for otitis media
Paracetamol, po, 4-6 hourly prn
for pain and fever
For patient with URT congestion
secondary to allergy:
* Cetirizine, po, daily for 10 days
When to refer in otitis media?
Severe pain, fever or vomiting, not
responding to treatment after 72
hours (if otoscopy confirmed) or
after 24 hours (if otoscopy
unconfirmed).
* Recurrent otitis media.
* Painful swelling behind the ear or
tenderness on percussion of the
mastoid.
* Suspected meningitis
Describe Chronic suppurative otitis media
A purulent discharge from the ear
with perforation for > 2 weeks. If
the eardrum has been ruptured for
≥ 2 weeks, a secondary infection
with multiple organisms usually
occurs.
* Oral antibiotic treatment is
generally ineffective.
* TB may present with a chronically discharging ear. Consider the diagnosis of TB if other clinical features suggestive of TB are present (e.g. cough, weight loss,
failure to thrive, etc.).
General measures for chronic suppurative otitis media
Do not send pus swabs collected from the external ear canal for routine bacterial and
fungal MC+S (microscopy, culture and sensitivity) or for microscopy and culture for
tuberculosis.
* Explain to patients and caregivers that a chronically draining ear can only heal if it is dry.
* Dry mopping is the most important part of the treatment. It should be demonstrated to
the child’s caregiver or patient if old enough. Roll a piece of clean absorbent cloth into a
wick.
- Do not leave anything in the ear.
- Do not instil anything else in the ear.
- Avoid getting the inside of the ear wet while swimming and bathing.
- Check HIV status if unknown
Explain how to do dry wicking
- Carefully insert the wick into the ear with twisting action.
- Remove the wick and replace with a clean dry wick.
- Repeat this until the wick is dry when removed.
