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Common ear problems :ear_of_rice: (:one:Acute otitis externa (AOE)âĶ
Common ear problems
:ear_of_rice:
3 groups
:two:
Hearing loss
:three:
Vertigo
:one:
Otalgia (earache), Otorrhea
:one:
Acute otitis externa (AOE)
Hx swimming, cotton bud user
PE swollen ear canal, :star:
painful on auricle movement:star:
+- Hearing loss
Rx
Topical ATBs
/
cotton wick
:warning:
no need for oral ATBs
Aural toilet
Analgesia
Advice cause
Malignant Otitis Externa
:fire:
PE Granulomatois polyploid otitis externa
Disproportionately severe pain
RF - Diabetes
Associated features: CN involvement - VII, IX, X, XI, XII
Rx
Topical ATB & Aural toilet
IV ATBs
Hyperbaric oxygen
Enumerate Levensonâs criteria
:sunflower:
When to refer :question: if
Non-responsive
Canal oedematous
Needs aural toilet
Suspicion of malignant OE
:two:
Acute otitis media
Hx: URI āļāļģāļĄāļēāļāđāļāļāđāļĨāđāļ§āđāļāļīāļ
Hearing Loss & earache
PE:
Normal
EAC, Red & bulging TM uni/bilateral,
no
pain on auricle movement
Rx
Systemic ATBs
Analgesia
Decongestants
Hearing loss & pain -> D/C, pain subsides
When to
refer
:question:
Failure of resolution
Persistent D/C
Complications
VII palsy
Mastoiditis
Complication
:oil_drum:
:three:
Chronic
otitis media
Hx Aural D/C
off & on
PE Tympanic mb perforation
+-Cholestoma, purulent D/C in middle ear
Rx
Consult ENT
:four:
Otitis media with effusion (OME)
/
Eustachian tube dysfunction**
Recurrent Hearing loss
Hx URI, AR, Sinusitis
PE Retracted TM, Air bubble in ME uni/bilat
Rx
If < 3 mo â try medical
If > 3 mo â
Surgical
if not improved
sx: āļāđāļē PE tube
:five:
Sudden sensorineural Hearing Loss (SSNHL)
Sudden onset of hearing loss
Hx Hearing before excretion, URI, Loud noise exposure
PE
Normal EAC & TM
Weber test: lateralize to better ear
Rinne test: positive both ear
Rx: need hospitalization / systemic steroid
:six:
Impacted cerumen
Hearing loss - insidious onset
Hx post ear picking +- pain
PE brown to black mass occluding EAC
Rx:
NaHCO3 / Suctioj remove
Advice cause, Avoid ear picking
:seven:
Ddx biopsy (tumor or Aural polyps)
âHearing loss &
Bloody D/C
â
Hx insidious onset, bloody D/C off & on
PE Abnormal mass in EAC
Rx
: consult ENT
:eight:
Ddx Hemotympanum
âHearing loss &
blue TM
â
Hx Post head injury/Barotrauma
PE Normal blood clot in EAC & Blue TM
Rx: conservation 2-4 wk
:nine:
Glomus tumor/High jugular bulb
âHearing loss +
Mass behind TM
â
Hx Insidious Onset, Pulsatile tinnitus
PE Normal EAC + Blue, red mass behind TM
Rx consult ENT
:one::zero:
Inner ear ds
(eg Meniereâs ds, Acoustic neuroma)
âHearing loss + Vertigo + Tinnitusâ
Rx:
Dimenhydrinate 1 tab
Rest
Consult ENT
:european_castle:
10-T refer otalgia
:!:
:warning:
whoa
Perichondrial hematoma
Rx by
Systemic ATBs
Analgesia
Urgent referral for Incision & Drainage
If Rx āđāļĄāđāļāļĩ â may cause Cauliflower ear (deformities)
Perichondrial cellulitis
Rx by
Systemic ATBs
Analgesia
Refer to ENT
if no response after 24 hr
āđāļāļ inflam at Ear but Spare ear lobule as no cartilage
Pinna seroma
No Hx of Trauma
Usually found in :male_sign:, 20-40 y/o
āļŦāļĨāļąāļāļŦāļĨāļąāļāđāļ āļāļāļāļ·āđāļāļĄāļēāļĄāļĩāļāļļāđāļĒāđ
āļāļđāđāļĨāđāļ§āđāļāđ serous
Rx
Adequate drainage (aspirate only may cause recurrence)
Refer ENT