Otitis Externa Quiz

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Questions and Answers

What is the most common cause of otitis externa?

Aspergillus species

Candida albicans

Staphylococcus aureus (correct)

Herpes simplex virus

What is the primary symptom of otitis externa?

Ear discharge

Ear pain (correct)

Hearing loss

Itching

What is the primary treatment for localized otitis externa (furunculosis)?

Surgery

Antifungal cream

Oral antibiotics

Topical antibiotics (correct)

What are the primary symptoms of fungal otitis externa?

Ear discharge with spores (D) Signup and view all the answers

Which of the following is NOT a common management strategy for otitis externa?

Antifungal medication (A) Signup and view all the answers

Why is ear wick insertion indicated in some cases of otitis externa?

To deliver medication to the deeper parts of the ear canal (B) Signup and view all the answers

What is the primary concern regarding viral otitis externa?

Facial nerve involvement (C) Signup and view all the answers

Which of the following is TRUE about the management of ear disorders?

Systemic antibiotics would be a good treatment option for a patient with a severe infection that is not responding to topical therapy (C) Signup and view all the answers

What is the most common organism responsible for Malignant (Necrotizing) Otitis Externa?

Pseudomonas aeruginosa (B) Signup and view all the answers

Which of the following is a common presentation of Acute Otitis Media (AOM)?

Ear pain, fever, irritability (C) Signup and view all the answers

Which of the following is NOT a potential cause of a Tympanic Membrane (TM) rupture?

Chronic earwax buildup (D) Signup and view all the answers

What treatment strategy is recommended for a hematoma in the pinna (auricle)?

Drainage to prevent necrosis (B) Signup and view all the answers

In the context of Malignant (Necrotizing) Otitis Externa, what is the preferred duration of anti-pseudomonal therapy?

8-12 weeks (B) Signup and view all the answers

What is the name of the procedure used to repair a perforated tympanic membrane if it does not heal spontaneously?

Myringoplasty (A) Signup and view all the answers

Which of the following is a potential complication of Chronic Suppurative Otitis Media (CSOM)?

All of the above (D) Signup and view all the answers

What is the recommended management for mild pediatric cases of Acute Otitis Media (AOM)?

Observation for 48 hours if no red flags (A) Signup and view all the answers

Which of the following is a possible cause of conductive hearing loss?

Otitis media (A) Signup and view all the answers

What is the most likely diagnosis if a patient presents with a foul-smelling ear discharge?

Cholesteatoma (A) Signup and view all the answers

Which of the following conditions is NOT an intracranial complication of chronic otitis media?

Facial Nerve Paralysis (C) Signup and view all the answers

What type of hearing loss is characterized by a lesion affecting the cochlea or auditory nerve?

Sensorineural (B) Signup and view all the answers

Which of the following is a common cause of sensorineural hearing loss?

Presbycusis (D) Signup and view all the answers

What is the significance of a Type B tympanometry finding?

No middle ear pressure or TM mobility (C) Signup and view all the answers

If a patient presents with unilateral hearing loss, tinnitus, and facial numbness, what is the most likely diagnosis?

Acoustic neuroma (C) Signup and view all the answers

Which of the following is considered part of the basic evaluation for hearing loss?

Tympanometry (C) Signup and view all the answers

Which of the following is NOT a common symptom associated with otitis media with effusion (OME)?

Pain (B) Signup and view all the answers

A patient presents with foul-smelling otorrhea, conductive hearing loss, and a history of recurring ear infections. Which condition is most likely the cause?

Cholesteatoma (C) Signup and view all the answers

What is the primary management approach for a patient with a safe type of tympanic membrane perforation?

Aural toilet and topical antibiotics (C) Signup and view all the answers

Which of the following is a risk factor for otitis media with effusion?

Adenoid hypertrophy (A) Signup and view all the answers

What is the primary goal of treatment for barotrauma?

Restore middle ear pressure (D) Signup and view all the answers

Which of the following procedures is often performed for persistent otitis media with effusion, especially with significant hearing loss?

Myringotomy with ventilation tube placement (D) Signup and view all the answers

What is the primary treatment for cholesteatoma?

Surgical removal (C) Signup and view all the answers

Identify the characteristic feature(s) of mastoiditis:

Pain and swelling behind the ear (A) Signup and view all the answers

Which of the following is a characteristic of Meniere's disease?

Recurrent episodes (20–30 minutes to hours), with hearing loss, tinnitus, aural fullness (D) Signup and view all the answers

Which of the following is NOT a common cause of peripheral vertigo?

Brainstem/cerebellar lesions (C) Signup and view all the answers

A patient presents with severe pain in their ear, edema of the external auditory canal, and a history of swimming. What is the most likely diagnosis?

Otitis externa (D) Signup and view all the answers

Which of the following is a characteristic of malignant otitis externa?

Severe nocturnal pain, granulation tissue, and cranial nerve involvement (B) Signup and view all the answers

Which of the following is a characteristic of cholesteatoma?

Aggressive squamous epithelium in the middle ear that erodes bone (B) Signup and view all the answers

Which of the following is a common complication of ear disorders?

Mastoiditis (D) Signup and view all the answers

Which of the following is a diagnostic tool used to distinguish between conductive and sensorineural hearing loss?

Tuning fork tests (A) Signup and view all the answers

Which of the following is the most appropriate treatment for otitis externa?

Topical drops (A) Signup and view all the answers

Study Notes

Ear Disorders: Comprehensive Notes

Anatomy Overview
- External Ear: Includes the auricle (pinna) and the external auditory canal (EAC).
- Middle Ear: Contains the tympanic membrane (eardrum), ossicles (malleus, incus, and stapes), and mastoid air cells.
- Inner Ear: Includes the cochlea (hearing) and the vestibular apparatus (balance).
- Eustachian Tube: Connects the nasopharynx to the middle ear, aiding pressure equalization.

External Ear Disorders

Otitis Externa (Swimmer's Ear)
- Definition: Inflammation/infection of the external auditory canal (EAC).
- Common Causes: Pseudomonas aeruginosa, Staphylococcus aureus.
- Clinical Features: Severe ear pain, scanty discharge, canal edema, possible conductive hearing loss.
- Management: Topical antibiotics, +/- topical steroids, ear wick for deep penetration of medication, systemic antibiotics (if needed), analgesia, and keeping ear dry.
Furunculosis (Localized Otitis Externa)
- Definition: Localized infection of a hair follicle in the lateral (cartilaginous) portion of the EAC.
- Symptoms: Pain, possible localized swelling/abscess.
- Management: Topical or oral antibiotics, incision, and drainage if abscess forms.
Otomycosis (Fungal Otitis Externa)
- Common Organisms: Candida albicans, Aspergillus species.
- Clinical Features: itching (pruritus), ear blockage, whitish or blackish discharge.
- Management: Careful suctioning/debridement of fungal debris, topical antifungals, and keeping the canal dry.
Viral Otitis Externa (Herpes Oticus)
- Cause: Herpes simplex virus, presenting with small vesicles in the EAC.

Malignant (Necrotizing) Otitis Externa

- Definition: Aggressive infection extending from the EAC to the skull base (osteomyelitis), often in immunocompromised or diabetic patients.
- Most Common Organism: *Pseudomonas aeruginosa*.
- Clinical Features: Severe, persistent otalgia, granulation tissue in the ear canal.
- Management: Prolonged anti-pseudomonal therapy, debridement of granulation tissue, and controlling any underlying immunosuppressive conditions (e.g., diabetes).

Ear Trauma

Auricular (Pinna) Trauma:
- Hematoma (subperichondrial): must be drained to prevent necrosis (cauliflower ear).
- Suture lacerations if needed; ensure no infection.
External Canal Trauma: Lacerations or bleeding; ensure no TM perforation. Manage with antiseptic measures.
TM (Eardrum) Rupture: Direct trauma, barotrauma (blast injury), or infection; may present with sudden pain, possible bloody otorrhea, hearing loss, and tinnitus. Most heal spontaneously.

Middle Ear Disorders

Acute Otitis Media (AOM)
- Definition: Acute inflammation of the middle ear, common in children.
- Pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.
- Clinical Features: Ear pain, fever, irritability, red, bulging tympanic membrane (TM), possible decreased TM mobility, possible TM perforation, and purulent discharge.
- Management: Systemic antibiotics (e.g., amoxicillin-clavulanate), analgesics, and antipyretics, observation sometimes in mild pediatric cases.
Chronic Suppurative Otitis Media (CSOM)
- Definition: Chronic perforation of the TM with persistent or recurrent ear discharge.
- Subtypes: Safe (tubotympanic); Unsafe (atticoantral).
- Clinical Features: Otorrhea (often foul-smelling), conductive hearing loss.
- Management: Aural toilet (suctioning, cleaning), topical antibiotics (e.g., quinolones), water precautions, and possibly surgery.
Otitis Media with Effusion (OME) / Serous Otitis Media / “Glue Ear”
- Definition: Fluid in the middle ear without acute signs of infection.
- Causes: Eustachian tube dysfunction (e.g., adenoid hypertrophy, allergy).
- Symptoms: Hearing loss, fullness, no significant pain.
- Management: Address underlying cause, observe if mild, many resolve spontaneously.
Cholesteatoma:
- Definition: Keratinizing squamous epithelium that can erode surrounding structures.
- Pathogenesis: Retraction pockets, TM perforation, squamous epithelium migration.
- Clinical Features: Foul-smelling otorrhea, conductive hearing loss, can erode ossicles, facial nerve, semicircular canal.
- Management: Surgical removal (mastoidectomy), reconstruction (tympanoplasty) may follow.
Mastoiditis: Infection spreads to mastoid air cells; presents with postauricular pain, swelling.
Barotrauma (Aerotitis)
- Definition: Middle ear injury due to pressure changes (flying, diving).
- Clinical Features: Ear pain, TM retraction, possible fluid or hemorrhage behind TM.
- Management: Avoiding rapid pressure changes (e.g., chewing gum), Decongestants, nasal steroids to help Eustachian tube function.

General Clinical Presentations

Otorrhoea (Ear Discharge): Can arise from external or middle ear pathology.
Otalgia (Ear Pain): Primary from external or middle ear pathology or referred pain (e.g., throat, TMJ).
Hearing Loss: Can be conductive (external/middle ear lesions) or sensorineural (inner ear lesions).

Vertigo and Imbalance

Definition: False sense of movement/spinning.
Causes: Peripheral (inner ear/vestibular) or central (brainstem/cerebellar lesions).
Common causes of peripheral vertigo: Benign paroxysmal positional vertigo (BPPV), Meniere's disease, labyrinthitis, and vestibular neuritis/labyrinthitis.

High-Yield Considerations

Otitis Externa: Severe pain, edema, Pseudomonas. Topical drops are mainstay.
Malignant Otitis Externa: Elderly/diabetic, severe nocturnal pain. Urgent anti-pseudomonal treatment.
Acute Otitis Media: Common in children; ear pain, fever, red TM. Treat with antibiotics and analgesics.
Chronic Suppurative OM: Persistent discharge. Watch for cholesteatoma.
Cholesteatoma: Aggressive epithelium, foul discharge, needs surgery.
Conductive/Sensorineural HL: Differentiate using tuning forks & audiometry.
Complications: Mastoiditis, labyrinthitis, petrositis, suspect intracranial spread with persistent fever/neurological deficits.

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Description

Test your knowledge on otitis externa, its causes, symptoms, and treatment options. This quiz covers various aspects including fungal infections, management strategies, and complications related to ear disorders. Perfect for students pursuing medical or health-related fields.