#passmed 2023 > Otitis Externa > Flashcards

Otitis Externa Flashcards

(33 cards)

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1
Q

What is Otitis externa?

A

Inf of external ear

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2
Q

What groups of people is Otitis externa more prevalent in? (2 things)

A
  1. Young age
  2. Females
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3
Q

What is the pathophysiology of Otitis Externa? (5 steps)

A
  1. Disruption to EAC protective mechanisms
  2. Pathogen overgrowth / inflamm
  3. Skin –> erythematous / swollen / tender / warm
  4. Debris + discharge accum –> canal narrowing
  5. Further entrapment of pathogens
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4
Q

What can lead to Disruption to EAC protective mechanisms? (3 steps)

A
  1. Repeated water exposure (interrupts wax formation)
  2. Trauma to canal (cotton buds)
  3. Blockage (debris)
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5
Q

What are the most common causative pathogens of OE? (3 things)

A
  1. Pseudomonas aeruginosa (40%)
  2. S. epidermidis
  3. S. aureus
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6
Q

What are the RF for OE? (7 things)

A
  1. Freq water contact (e.g swimmers / freq hair washers)
  2. Humid environments
  3. Ear polyps / foreign bodies
  4. Narrow ear canals
  5. Ear eczema / Psoriasis
  6. Trauma (hearing aids / cotton buds)
  7. Immunocompromised / DM (inf risk)
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7
Q

What are the RF for OE? (7 things)

A
  1. Freq water contact (e.g swimmers / freq hair washers)
  2. Humid environments
  3. Ear polyps / foreign bodies
  4. Narrow ear canals
  5. Ear eczema / Psoriasis
  6. Trauma (hearing aids / cotton buds)
  7. Immunocompromised / DM (inf risk)
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8
Q

What is the classical clinical picture of OE?

A

Progressive ear pain + purulent discharge

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9
Q

What are the CF of OE? (4 things)

A
  1. Pain
  2. Discharge
  3. Itchiness
  4. Conductive Hearing Loss (if ear blocked)
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10
Q

What are the CF of OE? (4 things)

A
  1. Pain
  2. Discharge
  3. Itchiness
  4. Conductive Hearing Loss (if ear blocked)
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11
Q

What will you see @ exam of OE? (4 things)

A
  1. Erythema / swelling
  2. Pus / discharge
  3. Tenderness
  4. Lymphadenopathy in neck / around ear
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12
Q

What does White / yellow Pus indicate?

A

Bac inf

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13
Q

What does Thick white grey w spores Pus indicate?

A

Fungal inf

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14
Q

What does Clear grey Pus indicate?

A

Otitis media

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15
Q

What are some DDx that present similarly to OE? (3 things)

A
  1. Otitis media w Perforation
  2. Ramsay Hunt syndrome
  3. Furuncle
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16
Q

How is OM w Perforation different to OE? (3 things)

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A
  1. Clear / bloody discharge
  2. Pain relieved after discharge
  3. Tympanic memb inflamm + Perforated
17
Q

How is Ramsay Hunt syndrome different to OE?

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A

Vesicular rash within 2 days of first onset of pain

18
Q

How is Furuncle different to OE?

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A

Visible bulge present @ otoscope exam

19
Q

How is the Dx of OE made?

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A

Clinical Dx (based on thorough Hx + otoscopy)

20
Q

When should you do further investigations for OE? (4 things)

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A
  1. Not responding to Abx
  2. Signs of fungal disease @ otoscopy
  3. Recurrent disease
  4. Complicated disease
21
Q

What further investigations can you do for OE? (3 things)

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A
  1. Swabs of discharge –> send for culture
  2. Glucose levels for DM (in recurrent disease)
  3. High Res CT scan (HRCT) (for complicated disease)
22
Q

What is the main things in Mx of OE? (4 things)

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A
  1. Prevention
  2. Aural toileting
  3. Topical abx
  4. Simple analgesia
23
Q

What Topical abx is sued for OE?

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A

No single regime has been found to be the best

24
Q

Therefore what does Abx choice depend on for OE? (3 things)

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A
  1. Pt / doctor preference
  2. Local sensitivities
  3. Side fx
25
What can you give to decrease swelling of Canal + reduce pain?
Steroid drops
26
What are the Prevention options for OE? (4 things)
1. Remove debris by Microsuction 1. Avoid swimming + cotton buds 1. Use Bone-achored hearing aid (BAHA) (if dey need a hearing aid) 1. TUC (eczema / polyps)
27
What are the complications of OE? (4 things)
1. Malignant OE 1. Mastoiditis 1. Osteomyelitis 1. Intracranial spread
28
What is Malignant OE?
Spread of OE into Mastoid + Temporal bones
29
Who does Malignant OE typically occur in? (2 things)
1. Elderly DM pt 1. Immunocompromised pt
30
What are the CF of Malignant OE? (2 things)
1. Severe pain 1. Headaches
31
What investigation should you do for sus Malignant OE?
Urgent CT scan
32
What neurological involvement could Malignant OE cause?
CN 7 involvement
33
What is the Mx for Malignant OE?
IV abx (for debridement)
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