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External ear diseases (Otitis Externa (Otoscopy (•Bacterial OE: the canal…
External ear diseases
Otitis Externa
- patient history:
• 1 to 2 days of ear pain
• Exposure to water
• Itching
• Purulent discharge
• Conductive hearing loss
• Feeling of fullness or pressure
- On physical examination:
• Pain on gentle traction of the external ear
• Periauricular adenitis
• erythema, edema of the epithelium, and accumulation of moist debris in the EAC
• Spores and hyphae may be seen in the external canal if etiology is fungal
• Eczema of the pinna may be present
• CN involvement is not associated with simple otitis externa.
- Bacterial or mycotical infection of external auditory canal
- categorized by time course
– Acute
– Subacute
– Chronic > 4 weeks
- Acute otitis externa occurs in 4 of every 1000 people per year
- chronic when the duration of the infection exceeds 4 weeks or more than 4 episodes in 1 year
Otoscopy
-
•Fungal OE: black dots (spores) are the appearance of fungal infection (aspergillus niger), with other fungi the spores may be white or yellow
•Chronic otitis externa: canal wall is not swollen, the skin is red. The TM is normal.
due to:
Pseudomonas species
Staphylococci , Streptococci
Fungi (Aspergillus/Candida species)
Imaging is not required for simple otitis externa but, in patients with malignant otitis media (diabetic or immunocompromised): scan using CT with contrast
- treatment:
•Acetic acid with and without hydrocortisone
•Neomycin, polymyxin B, and hydrocortisone
•Ciprofloxacin, Ofloxacin
•Nystatin powder (Mycostatin, Nilstat)/Boric acid powder
Acute otitis externa
- mild to moderate stage
•bacterial infection
•Symptoms –Pain & pruritus
•Signs –Erythema, edema, Canal debris, Discharge, Hearing loss
- severe stage
•Severe pain, worse with movement
•Signs –Lumen obliteration, Purulent otorrhea, Involvement of periauricular soft tissue, Hearing loss, Temperature >37,5 C
- treatment
•Most common pathogens: P. aeruginosa, S. aureus
•Four principles
–canal cleaning (70% Spir. Vini)
–Topical antibiotics (Ciprofloxacine)
–Pain control (ointments with steroids)
– prevention
- Chronic otitis externa (COE)
•symptoms: pain, pruritus, (> 1 months)
•Dry skin canal
•Flaky skin
•Hypertrophied skin
•purulent otorrhea
•Topical antibiotics
•Frequent cleaning with 70% alcohol
•Topical steroids
•No surgical intervention
- Malignant otitis externa - most serious
•Type of chronic otitis externa caused by bacteria (P. aeruginosa) or fungi
•In patients with uncontrolled diabetes
•IV antibiotics for at least 4 weeks
•Ciprofloxacin, Ceftazidime, Ticarcillin/clavulanate (Timentin)
•Local canal debridement until healed
•Pain control
•Surgery only if necrosis is present
- Herpes zoster oticus
•viral infection, caused by varicella zoster
•Ramsey Hunt syndrome: herpes zoster of the pinna with otalgia and facial paralysis
•Early symptoms: pain in one ear, headache, malaise and fever
•Late symptoms (3 to 7 days): vesicles, facial paralysis
•Corneal protection
•Oral steroid (10 to 14 days)
•Antivirals (Acyclovir)
•Analgesic drugs
•Cleaning of EAC
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