Otitis Externa PDF

Otitis Externa Q: What is Otitis Externa (OE)? A: Otitis Externa is the inflammation of the external auditory canal (EAC). It can be caused by a viral, fungal, or bacterial infection. Q: What are the types of viral Otitis Externa? A: There are two main types of viral Otitis Externa: 1. Herpes...

Otitis Externa Q: What is Otitis Externa (OE)? A: Otitis Externa is the inflammation of the external auditory canal (EAC). It can be caused by a viral, fungal, or bacterial infection. Q: What are the types of viral Otitis Externa? A: There are two main types of viral Otitis Externa: 1. Herpes Simplex: This type occurs with fever and is characterized by vesicles. 2. Herpes Zoster: Caused by the chickenpox virus, it is characterized by painful vesicles. Q: What is Ramsay-Hunt Syndrome? A: Ramsay-Hunt Syndrome is a specific type of herpes zoster oticus and is characterized by: Vesicles around the ear, Otalgia (ear pain), Facial paralysis (7th cranial nerve involvement), SNHL (sensorineural hearing loss) and vertigo (involvement of the 8th cranial nerve). Q: How is Ramsay-Hunt Syndrome treated? A: Treatment includes: Analgesics for pain relief. Acyclovir, both locally and systemically, to treat the viral infection. Q: What is Bullous Myringitis? A: Bullous myringitis is characterized by bullae (blisters) filled with serous fluid or blood, located on the outer layer of the eardrum (tympanic membrane). Q: What is the treatment for Bullous Myringitis? A: Treatment involves: Analgesics to alleviate pain. Antibiotics, both local and systemic, to prevent secondary infections. Q: What is Otomycosis? A: Otomycosis is a fungal infection of the external auditory canal (EAC), often caused by fungi like Aspergillus Niger and Candida albicans. Q: What are the common symptoms of Otomycosis? A: Common symptoms of Otomycosis include: Itching in the external auditory canal (EAC). Deafness if the EAC becomes obstructed by fungal growth. Q: What are the clinical signs of Otomycosis? A: Clinical signs include: A fungal mass in the EAC that appears like a wet newspaper, with a white mass and black spots present. Q: How is Otomycosis treated? A: Treatment for Otomycosis involves several steps: 1. Local cleaning of the EAC using suction or ear wash to remove debris. 2. Antifungal ear drops, such as: o Nystatin ear drops. o Salicylic acid 2% (keratolytic) mixed with 70% alcohol (fungicidal). 3. If the infection is resistant, packing the EAC with an antifungal cream on a piece of gauze for prolonged treatment. Q: What are the different types of bacterial Otitis Externa (OE)? A: There are three types of bacterial Otitis Externa: 1. Localized OE (Furuncle): Infection of a hair follicle. 2. Diffuse OE: Involves the entire external auditory canal. 3. Malignant OE: Severe form that can lead to complications. Q: What is Localized Otitis Externa (Furuncle)? A: Localized Otitis Externa, or furuncle, is a Staphylococcal infection of a hair follicle, which typically occurs in the outer third of the external auditory canal (EAC). Q: What are the predisposing factors for Localized Otitis Externa (Furuncle)? A: One of the key predisposing factors for furunculosis is diabetes, as it can cause recurrent and multiple furuncles in diabetic patients. Q: What are the symptoms of Localized Otitis Externa (Furuncle)? A: Symptoms include: Pain that increases when chewing (mastication). Discharge that is scanty, purulent (pus-like), and cheesy. Deafness if the EAC is obstructed by the infection. Q: What are the clinical signs of Localized Otitis Externa (Furuncle)? A: Signs include: Tenderness when pulling the auricle or applying pressure on the tragus. Internal swelling in the EAC, which is reddish (only in the outer third of the canal where hair follicles are present).  External swelling with enlarged, tender pre- and post-auricular lymph nodes. Q: How is Localized Otitis Externa (Furuncle) investigated? A: In recurrent cases, blood sugar levels should be checked to investigate for possible underlying diabetes. Q: What is the treatment for Localized Otitis Externa (Furuncle)? A: Treatment includes: General Treatment: o Antibiotics and analgesics for pain relief. Local Treatment: o Local cleaning of the EAC with suction (avoiding ear wash to prevent spreading the infection). o 10% Glycerin Icthyol ear drops (glycerin is hygroscopic, and icthyol is a counter-irritant). o Packing the EAC with a cream containing antibiotics and steroids. o Incision and drainage if an abscess has formed. Q: What should be avoided when treating a furuncle in Otitis Externa? A: Squeezing the furuncle should be avoided as it can lead to perichondritis, which is an infection of the surrounding cartilage. Q: What is Diffuse Otitis Externa (OE)? A: Diffuse Otitis Externa is the inflammation of the entire external auditory canal (EAC), rather than being localized to a specific area. Q: What are the predisposing factors for Diffuse Otitis Externa (OE)? A: Some of the key predisposing factors include: Scratching of the EAC. Swimming in an infected swimming pool. Excessive sweating. Seborrhea (a skin condition). Diabetes, which can make the condition more recurrent. Q: What are the symptoms of Diffuse Otitis Externa (OE)? A: Symptoms include: Pain, which increases with mastication (chewing). Scanty, purulent discharge. Deafness if the EAC becomes obstructed by swelling or discharge. Q: What are the clinical signs of Diffuse Otitis Externa (OE)? A: Clinical signs include: Tenderness when pulling the auricle or applying pressure to the tragus. Internal swelling of the EAC, which appears diffuse, red, and edematous. External swelling with enlarged, tender pre- and post-auricular lymph nodes. Q: How is Diffuse Otitis Externa (OE) investigated? A: Investigations include: 1. Blood sugar testing for diabetes, especially in recurrent cases. 2. Culture and sensitivity of the discharge, particularly if the condition is resistant to initial treatments. Q: What is the treatment for Diffuse Otitis Externa (OE)? A: Treatment includes: General Treatment: o Antibiotics and analgesics for pain relief and to treat the infection. Local Treatment: o Local cleaning of the EAC using suction (avoid ear wash as it may spread the infection). o 8% Aluminium acetate packing (acts as an astringent to reduce swelling). o Packing the EAC with a cream containing both an antibiotic and a steroid for further treatment. Q: What is Malignant Otitis Externa (MOE)? A: Malignant Otitis Externa (MOE), also known as skull base osteomyelitis or necrotizing otitis externa, is a severe infection that starts in the external auditory canal (EAC) as cellulitis and spreads to involve the skull base, causing osteomyelitis. Q: What is the causative organism for Malignant Otitis Externa (MOE)? A: The primary causative organism for Malignant Otitis Externa is Pseudomonas aeruginosa, a type of bacteria. Q: What are the predisposing factors for Malignant Otitis Externa (MOE)? A: Low immunity, such as that seen in diabetes, is a significant predisposing factor for Malignant Otitis Externa. Q: How do the symptoms of Malignant Otitis Externa differ from those of Diffuse Otitis Externa? A: While Malignant Otitis Externa shares symptoms with Diffuse Otitis Externa (such as pain and discharge), the pain in MOE is severe, prolonged, and deeply seated. It can be much more intense and persistent. Q: What are the clinical signs of Malignant Otitis Externa? A: The clinical signs of Malignant Otitis Externa are similar to those of Diffuse Otitis Externa but can extend to the bony-cartilaginous junction of the EAC. Q: What are the potential extensions of Malignant Otitis Externa due to osteomyelitis? A: Extensions due to osteomyelitis may lead to: 1. Facial palsy (due to compression at the bony-cartilaginous junction). 2. Parotid swelling. 3. Lower cranial nerve palsy (especially affecting the lower 4 cranial nerves due to compression at the jugular foramen). 4. Trigeminal facial pain if the infection extends to the petrous apex of the temporal bone. Q: What investigations are required for Malignant Otitis Externa? A: Key investigations include: 1. Culture and sensitivity to confirm infection with Pseudomonas aeruginosa. 2. Fasting blood sugar to check for diabetes or blood sugar abnormalities. 3. CT Scan to assess the extent of the infection. 4. Gallium and Technetium bone scans to assess bone involvement. 5. Biopsy from granulations to exclude the possibility of a tumor. Q: What is the treatment for Malignant Otitis Externa? A: Treatment involves: Hospitalization and control of diabetes (if present). Systemic antibiotics: Quinolones, such as Ciprofloxacin, to treat the infection caused by Pseudomonas aeruginosa. Local cleaning of the EAC using suction. Local antibiotics: Ciprofloxacin ear drops for direct treatment of the infection in the EAC. Surgical debridement: May be required if there is necrotic tissue or abscess formation.