ENT Masterclass: Otitis Externa/ Tonsillitis - Semantic Scholar

ENT Masterclass: Otitis Externa/ Tonsillitis

25th Jan 2011

Mr Ali Kalan Mr Anooj Majithia

Otitis Externa

Otitis Externa: inflammation of external ear canal, due to: o infection (usually bacteria, e.g. Pseudomonas aeruginosa or Staphylococcus aureus or, rarely, fungi or yeasts, especially after antibacterial therapy) o allergies o irritants o can occur as a complication of eczema, psoriasis or other skin conditions

? Epidemiology: life-time prevalence 10%, typically affects females age 4554 years and males age 65-74 years

Otitis Externa

Clinical presentation: ? pain, fullness or pressure in ear ? decreased hearing ? which is usually mild ? itching in external ear canal ? tenderness in ear canal ? scanty discharge - there are no mucous secreting glands in the external ear; profuse discharge suggests middle ear disease ? pain and purulent discharge- only if secondary bacterial infection occurs

The condition may be generalised (diffuse) throughout ear canal (may be acute, acute-recurrent or chronic); or localised inflammation (furuncle) within ear canal.

History: ? nature and duration of symptoms; pain may not be prominent with chronic OE, which rather may be associated with itch and discomfort, whether recurrent, whether unilateral or bilateral ? nature of any discharge ? whether there is bleeding ? presence of risk factors for OE: water exposure, e.g. swimmers, divers, humid environments ? over-use of cotton buds ? history of eczema or psoriasis ? possible contact dermatitis, e.g. from shampoo or soap, earrings, hair dye, hearing aid ? diabetes mellitus ? Immuno-compromised, e.g. steroids, HIV ? systemic symptoms suggestive of sepsis ? malignant otitis externa is more common in the elderly diabetic

On examination:

? pain on gentle pulling on external ear, narrowed, oedematous meatus ? meatal debris ? tenderness on moving jaw ? +/- tender regional lymph nodes ? assess for facial nerve palsy (may complicate severe OE such as necrotising

OE or herpetic OE) ? temperature ? signs of dermatitis around the pinna ? on otoscopy: o erythema, oedema and debris in ear canal o scanty white discharge o eardrum inflamed but intact ? if chronic, the following features may be present: o thickened abnormal skin in ear canal o reduced production of ear wax o bloody or muco-purulent discharge

Investigations

screen for Diabetes Mellitus (important predisposing factor for OE in adults) in recurrent or chronic OE or in suspected malignant OE

? ear swab for Gram stain and culture of ear canal discharge is not routinely required unless there is evident discharge and/or condition is chronic or previous treatment has failed

(Tuning fork tests may demonstrate mild conductive deafness)

Management 1

prescribe suitable eardrops containing antibiotic and anti-inflammatory: Gentisone-HC contains gentamicin and hydrocortisone appropriate for most bacteria including anaerobes such as pseudomonas

? note that review of the evidence suggests no clinical benefit with the use of oral antibiotics plus topical anti-infective agents compared with topical anti-infective agents alone

? fungal infection o if persistent otitis externa then consider the possibility of a fungal

infection and treat with topical preparation containing an antifungal, such as clotrimazole 1% ear drops (Canesten?), or flumetasone pivalate 0.02%, clioquinol 1% ear drops (Locorten-Vioform?)

? Refer for aural toilet if there is no response

Management 2

? Educate the patient re general principles of prevention: o not to poke the ear at all o to use olive oil for wax removal and minor irritation o not to rub ears when drying after washing/swimming after bathing or swimming, all water in the ear canals should be

drained out by tilting the head to the sides the external ear canal should be then dried using a hair dryer on the

lowest heat setting. acidifying drops (vinegar) with alcohol drops can be used as

prophylactic after each swim (2) o can be prevented by maintaining a dry ear and avoiding the many

above mentioned precipitants o insertion of cotton swabs into the ear canal and any manipulation of

the canal should be avoided ? If no response in one week then consider an alternative eardrop (if

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download