#12132 - Ear Infections - ENT

Ear Infections

Otitis Externa

“Swimmers ear”

Acute inflammation of the skin of the meatus

Causative organisms

• Pseudomonas

• Staph aureus

• Mixed growth

• Fungal

Clinical features

• Itching, irritation

• Otalgia

• Usually mild otorrhoea

On examination

• Red, tender ear canal +/- thin discharge

• Tragal tenderness

• Pre-auricular lymphadenopathy

• May result in hearing loss due to oedema of the ear canal with accumulation of debris

Management

• Clean ear with suction

• Topical antibiotic drops e.g gentamycin short term + steroid

• Suggest precautions e.g ear plus when swimming

Malignant otitis externa

• Aggressive infection of the external ear that can lead to temporal bone destruction and basal skull osteomyelitis

• Pseudomonas usually responsible

• Affects immunocompromised and diabetic patients

• Causes granulations in floor of ear canal (normal TM)

• May cause cranial nerve palsies (facial nerve initially but may also involve glossopharyngeal, vagus and hypoglossal nerves)

• Treatment requires prolonged antibiotics +/- surgical debridement

Acute otitis media

• Common ear infection

• Responsible organisms often from the austacian tube

  • Strep. Pneumonia

  • H. Influenza

  • Or viral following URTI

Clinical features

• Fever

• Severe otalgia (due to increased pressure in middle ear)

• Conductive deafness

• Eardrum retracted (Blocked ET = -ve pressure) - Exudate forms - Eardrum bulges

• Pus in middle ear

• If TM perforates = bloodstained discharge + relief from pain

Management

• Analgesia

• Oral antibiotics e.g amoxicillin if systemically unwell or >72hrs

• Topical antibiotics if perforation

Complications

• Abscess (temporal, cerebellar or extradural)

• Acute mastoiditis

• Meningitis

• Facial nerve palsy

Chronic otitis media

• Follows a slow-to-heal acute otitis media

  • Persisting inflammation and failure or TM to heal

• Safe perforations

  • Result of recurrent AOM

  • Usually pars tensa

  • If discharging – aural toilet + topical steroid drops

  • Hearing aids for hearing loss

  • Is discharge persists – tympanoplasty

• Unsafe perforations

  • Atticoantral disease

  • Due to longstanding Eustachian tube dysfunction

  • Associated with cholesteatoma

Otitis Media with effusion/glue ear

Commonest cause of conductive acquired hearing loss in children

Epidemiology

• Peak age gap 2-6 yrs

• Increased incidence in children with Down syndrome/cleft palate

• Seasonal variation (URTIs)

Aetiology

• Usually eustacian tube dysfunction (normal ventilation of middle ear is disturbed)

• Causes chronic effusion

Clinical features

• Conductive hearing loss (flat trace on tympanogram)

• Recurrent otalgia

• Retraction of eardrum

• TM may look yellow-ish due to effusion

  • May be serous, mucoid or thick

Management

• If effusion persists + hearing affected, surgery may be required to restore healing

  • Removal of adenoids, decreases incidence of recurrent effusions

  • Myringotomy, fluid aspiration and grommet insertion immediately restores hearing

  • Grommets ventilate middle ear and prevent accumulation of mucus

  • Grommets may remain in TM for up to 12 months before being extruded

  • Following grommet extrusion, common to see tympanosclerosis (doesn’t impair hearing)

Complications of middle ear infections

• Extracranial

  • Acute mastoiditis

    • Osteomyelitis in mastoid bone

    • Occurs in younger children

    • Inflammation of mastoid lining produces severe pain localized over the mastoid process

    • Suggested by a gradual increase in pain with tachycardia + pyrexia

    • Oedema and then abscess formation can cause the ear to protrude forwards

    • ...