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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
...
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