membrane looks normal. What is the tx option?
a. Gentamicin topical
b. Amoxicillin PO
c. Analgesia
d. Amoxicillin IV
Answer: A, external otitis, swimmers ear
n.b. Acute otitis media will have pus only if the TM perforates
Otitis externa
• bacteria (~90% of OE):
Pseudomonas aeruginosa, Pseudomonas vulgaris, E. coli, S. aureus
• fungus: Candida
albicans, Aspergillus niger
Risk Factors
• associated with swimming (“swimmer’s ear”)
• mechanical cleaning
(Q-tips®), skin dermatitis, aggressive scratching
• devices that occlude the
ear canal: hearing aids, headphones, etc.
• allergic contact dermatitis, dermatologic
conditions (psoriasis, atopic dermatitis)
Clinical Features
• acute
-
pain aggravated by
movement of auricle (traction of pinna or
pressure over tragus)
-
otorrhea (sticky yellow purulent discharge)
-
conductive hearing
loss
± aural fullness 2ยบ to obstruction of
external canal by swelling and purulent debris
-
posterior
auricular lymphadenopathy
-
complicated OE
exists if the pinna and/or the periauricular soft tissues are erythematous and swollen
• chronic
-
pruritus of
external ear ± excoriation of ear canal
-
atrophic and
scaly epidermal lining, ± otorrhea, ± hearing loss
-
wide meatus but no
pain with movement of auricle
-
tympanic membrane
appears normal
Treatment
of otitis externa is:
- topical antibiotic or a combined topical antibiotic with steroid
- if the tympanic membrane is perforated aminoglycosides are traditionally not used
- if there is canal debris then consider removal
- if the canal is extensively swollen then an ear wick is sometimes inserted
Second line options include
- oral antibiotics if lymphadenopathy or cellulitis present
- taking a swab inside the ear canal
- use of a topical antifungal agent if fungal etiology suspected
- chronic otitis externa (pruritus without obvious infection) : corticosteroid alone (e.g. diprosalic acid)
No comments:
Post a Comment