Otitis Externa Slides PDF

12/12/2022 ENT TOPICS- OTITIS EXTERNA PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES Upon completion of this lecture, student will be able to: List the risk factors associated with otitis external Understand the pathophysiolo...

12/12/2022 ENT TOPICS- OTITIS EXTERNA PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES Upon completion of this lecture, student will be able to: List the risk factors associated with otitis external Understand the pathophysiology associated with otitis external Describe the clinical presentation and work up of a person with otitis external Develop a medical plan for a person with otitis external 1  12/12/2022 INTRODUCTION Otitis externa (OE) is an inflammation or infection of the external auditory canal (EAC), the auricle, or both. This condition can be found in all age groups. CLASSIFICATION OF OE Acute diffuse OE - Most common form Eczematous OE - Encompasses various of OE, typically seen in swimmers dermatologic conditions such as atopic dermatitis, psoriasis, systemic lupus Acute localized OE - Associated with erythematosus, and eczema. infection of a hair follicle Necrotizing (malignant) OE - Infection that Chronic OE - Same as acute diffuse OE extends into the deeper tissues adjacent to but is of longer duration (>6 weeks) the EAC; occurs primarily in Otomycosis - Infection of the ear canal immunocompromised adults (eg, diabetics, from a fungal species. patients with AIDS) 2  12/12/2022 PATHOPHYSIOLOGY The processes involved in the development of OE If moisture is trapped in the EAC, it may cause can be divided into the following: maceration of the skin and provide a good breeding ground for bacteria. Obstruction (eg, cerumen buildup, surfer’s exostosis, or a narrow or tortuous canal), Obstruction of the EAC by excessive cerumen, debris, resulting in water retention surfer’s exostosis, or a narrow and tortuous canal may also lead to infection by means of moisture retention. Absence of cerumen, which may occur as a result of repeated water exposure or overcleaning the Once infection is established, an inflammatory ear canal response occurs with skin edema. Exudate and pus Trauma often appear in the EAC as well. If severe, the infection may spread and cause a cellulitis of the face or neck. Alteration of the pH of the ear canal PRESENTING SYMPTOMS Otalgia - Ranges from mild to severe, typically Discharge - Initially, clear; quickly becomes progressing over 1-2 days purulent and foul-smelling Hearing loss Cellulitis of the face or neck or lymphadenopathy Ear fullness or pressure of the ipsilateral neck (occasionally) Erythema, edema, and narrowing of the EAC Bilateral symptoms (rare) Tinnitus History of exposure to or activities in water Fever (frequently) (eg, swimming, surfing, kayaking) Itching (especially in fungal OE or chronic OE) History of preceding ear trauma (usually) (eg, Severe deep pain - Immunocompromised patients may forceful ear cleaning, use of cotton swabs, or have necrotizing OE water in the ear canal) 3  12/12/2022 PHYSICAL EXAM The key physical finding of OE is pain upon palpation of the tragus (anterior to ear canal) or application of traction to the pinna (the hallmark of OE). Examination reveals erythema, edema, and narrowing of the external auditory canal, and a purulent or serous discharge may be noted. Conductive hearing loss may be evident. Cellulitis of the face or neck or lymphadenopathy of the ipsilateral neck occurs in some patients. DIFFERENTIAL DIAGNOSIS Ear canal trauma Furuncle Ear canal carcinoma Skull base osteomyelitis Otitis media with a perforation Preauricular cyst and fistula Chondritis Lacerations Cranial nerve palsy Atopic dermatitis Cerumen impaction Hearing loss Foreign body Wisdom tooth eruption Herpes Zoster Oticus Intracranial abscess 4  12/12/2022 TREATMENT Primary treatment of otitis externa involves Ciprofloxacin-Hydrocortisone and management of pain, removal of debris from Neomycin-polymyxin B-hydrocortisone are the canal, administration of topical first-line agents. medications to control edema and infection, Prescribe an initial seven-day course of and avoidance of contributing factors. topical medication with instructions to Otic antibiotic and steroid continue it for one additional week if combinations have shown to be highly symptoms have not resolved. successful in treatment, with cure Patients with moderate disease and rates of 87-97%. symptoms persisting after one to two weeks should be reevaluated for treatment failure. CONSIDERATIONS FOR THE GERIATRIC POPULATION Necrotizing external otitis typically occurs in older adult patients with diabetes mellitus or with immunocompromise. This involves infection and damage to the bones of the ear canal and at the base of the skull. Hallmark sign is granulation tissue in deep meatus at the bony cartilaginous junction. 5  12/12/2022 REFERENCES Buttaro, T. M., Trybulski, J., Bailey, P. P., & Sandburg-Cook, J. (2017). Primary care a collaborative practice. (5 ed.). St. Louis, Missouri: Mosby Elsevier. Waitzman, A. & Elluru, R. (2022, April 07). Otitis Externa. Retrieved June 17, 2022, from https://emedicine.medscape.com/article/994550-treatment#d7 6