![\"Relevant](\"https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2024\/04\/ear-anatomy.jpg?resize=300%2C252&ssl=1\")
Relevant Ear Anatomy<\/p><\/div>\n
<\/p>\n
<\/p>\n
OTITIS EXTERNA and OTITIS MEDIA
\n<\/b><\/h1>\nBY DR BULUS N G<\/h6>\nMAY HOSPITAL SHENDAM<\/h6>\n28\/03\/2024<\/h6>\n
MAY HOSPITAL SHENDAM<\/h6>\n28\/03\/2024<\/h6>\n
<\/p>\n
OUTLINE<\/h2>\n\n- INTRODUCTION<\/li>\n
- RELEVANT ANATOMY<\/li>\n
- PRIMARY FUNCTION OF THE EXTERNAL EAR<\/li>\n
- OTITIS EXTERNA<\/li>\n
- OTITIS MEDIA<\/li>\n
- PREVENTION<\/li>\n
- CONCLUSION<\/li>\n<\/ul>\n
<\/p>\n
INTRODUCTION<\/h2>\n\n- The ear is the organ of the body used for hearing and balancing.<\/li>\n
- Divided into three; the outer or external ear, middle ear and inner ear.<\/li>\n
- The outer and middle ear are responsible for conduction of sound impulses to the inner ear<\/li>\n
- The outer and middle ear are prone to exposure to various injurious agents.<\/li>\n
- This can result to inflammation of the outer or inner ear<\/li>\n
- Otitis Externa <\/b>is simply the inflammation of the outer opening of the ear and the ear canal.<\/li>\n
- Also referred to as the swimmers ear.<\/li>\n
- Otitis Media <\/b>Is the inflammation of the mucous membranes of the middle ear cavity (Eustachian tube, mastoid antrum, mastoid air cells and tympanic cavity).<\/li>\n
- Some causative organisms includes;1.Acute Bacterial Infection\n
2.Fungal Infection<\/p>\n
3.Acute Viral<\/p>\n
4.Associated with Allergy<\/li>\n<\/ul>\n
Primary functions of Ext Ear<\/p>\n
![\"\"](\"https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2024\/04\/Picture1.png?resize=300%2C225&ssl=1\")
<\/p>\n
<\/p>\n
<\/h2>\n<\/h2>\nOTITIS EXTERNA\u00a0\u00a0<\/b><\/h2>\n
CLINICAL FEATURES OF OTITIS EXTERNA<\/p>\n
\n- Pain<\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0Aggravated at night<\/li>\n
- \u00a0 \u00a0 \u00a0Worsened by contact with pinna<\/li>\n<\/ol>\n
\n- Swelling<\/li>\n
- Otorrhoea (non-mucoid)<\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0 Purulent<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 Watery<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0Desquamated tissues<\/li>\n<\/ol>\n
\n- Itching<\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0Otomycosis<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0Allergy<\/li>\n<\/ol>\n
\n- Tinnitus<\/li>\n
- Hearing loss- otorrhoea, stenosis & canal plug<\/li>\n
- Trismus \u2013when anterior canal wall \/TMJ are involved<\/li>\n
- Tragal tenderness<\/li>\n<\/ul>\n
<\/p>\n
BACTERIAL OTITIS EXTERNA<\/h2>\n\n- Common aetiology- Pseudomonas, Staph spp, Strep spp, gram negative rods spp<\/i><\/li>\n
- Localised e.g. Furunculosis<\/i><\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Hair root infections. <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0usually from staph. aureus<\/i><\/li>\n<\/ol>\n
\n- Generalised e.g. <\/i>Erisipelas<\/i><\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Acute streptococcal lymphangitis and dermatitis with propensity for\u00a0 rapid spread .<\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0commonly\u00a0 triggered by scratching.<\/i><\/li>\n<\/ol>\n
\n- +\/- purulent discharge<\/i><\/li>\n<\/ul>\n
Illustrations<\/p>\n
![\"\"](\"https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2024\/04\/Picture2.png?resize=300%2C140&ssl=1\")
<\/p>\n
<\/p>\n
FUNGAL OTITIS EXTERNA (OTOMYCOSIS)<\/h2>\n\n- Fungal infections of the ear(external)<\/li>\n
- Common agents<\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i>– nigra <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i> fumigatus\u00a0 <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i> flavus<\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Candida albicans<\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Yeast spp<\/i><\/li>\n<\/ol>\n
<\/p>\n
CLINICAL FEATURES OF OTOMYCOSIS<\/h2>\n\n- Invades the deeper layers of the skin unlike the bacterial OE.<\/li>\n
- Aggravated by moisture and humidity<\/li>\n
- Very itchy<\/li>\n
- Black, brown or dirty-white discharge<\/li>\n
- Cotton-like growth<\/li>\n
- Spores formation<\/li>\n
- Resistant and requires prolonged therapy<\/li>\n
- Tinnitus<\/li>\n
- Hearing loss<\/li>\n
- Exuberant and florid features in the immuno-compromised.<\/li>\n<\/ul>\n
<\/p>\n
VIRAL OTITIS EXTERNA<\/h2>\n\n- This is not as prevalent as bacterial or fungal.<\/li>\n
- Herpes simplex (H. simplex virus 1)<\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0characterised by inflammed mucosa<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Assoc with clear fluid discharge.<\/li>\n<\/ol>\n
\n- Herpes zoster(Varicella varice)<\/li>\n<\/ul>\n
\n- Assoc with vesicular eruption within EAC<\/li>\n
- Paralysis of VII & other CNs may result (Ramsay \u2013Hunt syndrome).<\/li>\n<\/ol>\n
\n- Bullous myringitis causative org,<\/li>\n<\/ul>\n
\n- May be associated with influenza<\/li>\n
- Haemorrhagic vesicles on external\u00a0 surface of TM<\/li>\n<\/ol>\n
Illustrations<\/p>\n
![\"\"](\"https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2024\/04\/Picture3.png?resize=300%2C176&ssl=1\")
<\/p>\n
<\/p>\n
ATOPIC (ECZEMATOUS) & SEBORRHOEIC OTITIS EXTERNA<\/h2>\n\n- OE associated with atopy or allergic conditions.<\/li>\n
- Basically an allergic dermatitis\/irritation of the skin of the EAC.<\/li>\n
- May be similar to the seborrheic scalp infections .<\/li>\n<\/ul>\n
<\/p>\n
Features of Atopic Otitis Externa<\/h3>\n\n- Irritation<\/li>\n
- Scaling<\/li>\n
- Swelling<\/li>\n
- Weeping of the EAC skin<\/li>\n
- Secondary infections<\/li>\n<\/ul>\n
Illustrations<\/p>\n
![\"\"](\"https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2024\/04\/Picture4.png?resize=300%2C210&ssl=1\")
<\/p>\n
<\/p>\n
Investigations<\/h3>\n
I. Clinical findings key<\/p>\n
II. Microscopy culture and sensitivity<\/p>\n
III. Imaging<\/p>\n
\n- X-ray mastoid<\/li>\n
- CT scan<\/li>\n<\/ol>\n
IV. Pure Tone Audiogram<\/p>\n
Treatment<\/h3>\n\n- TOPICAL<\/li>\n<\/ul>\n
\n- Aural toileting<\/li>\n
- Keep ears dry<\/li>\n
- Topical antibiotics<\/li>\n
- Topical anti-inflammatory +\/- steroid<\/li>\n<\/ol>\n
\n- SYSTEMIC<\/li>\n<\/ul>\n
\n- Antibiotics<\/li>\n
- Analgesic<\/li>\n
- Antipruritic agents<\/li>\n<\/ol>\n
Differentials<\/h3>\n\n- Otitis externa maligna<\/li>\n
- Myringitis<\/li>\n
- Wax<\/li>\n
- Foreign bodies<\/li>\n
- Keratosis Obturans<\/li>\n
- Exostosis<\/li>\n
- Otitis media<\/li>\n
- Neoplasm<\/li>\n<\/ul>\n
<\/p>\n
<\/p>\n
OTITIS MEDIA<\/h2>\n
![\"\"](\"https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2024\/04\/Picture5.png?resize=300%2C118&ssl=1\")
<\/p>\n
Definition<\/h4>\n\n- Otitis media is simply inflammation or infection of the middle ear.<\/li>\n
- The mucosa of the middle ear cleft is the point of infection.<\/li>\n
- It is a global ear disease with health-economic burden.<\/li>\n
- Most prevalent(up to 11%) in Africa and developing world.<\/li>\n<\/ul>\n
CLINICAL FEATURES OF OTITIS MEDIA<\/h4>\n\n- Presents with varied clinical features depending on the duration, severity and progression of disease.<\/li>\n
- <\/li>\n
- Due to the complex contiguous relationship between middle ear and essential intracranial structures , complications could be bizarre.<\/li>\n
- Intra cranial and extra cranial sequelae results from untreated or poorly treated OM<\/li>\n
- The acute phase can get resolved<\/li>\n
- May progress to chronicity with attendant complications<\/li>\n
- Good Knowledge of Anatomy of middle ear is necessary for attendant physicians.<\/li>\n<\/ul>\n
Predisposing Factors<\/h4>\n\n- HOST-RELATED<\/b><\/li>\n<\/ul>\n
1.Age-highest incidence 6-11 months<\/p>\n
2.Sex \u2013nil preponderance<\/p>\n
3.Race \u2013inconclusive<\/p>\n
4.Prematurity \u2013 lowbirthweight(+ve)<\/p>\n
5.Allergy- (+ve)controversy in pathogenesis<\/p>\n
6.Immunocompetency<\/p>\n
7.Cleftplate\/craniofacial abromalities(+ve)<\/p>\n
8.Genetic predispo-(+ve)<\/p>\n
\n- \n
\n- ENVIRONMENTAL FACTORS<\/b><\/li>\n<\/ul>\n
1.URTI\/Seasonal<\/p>\n
2.Day care\/Home care\/sibs<\/p>\n
3.Tobacco smoke exposure<\/p>\n
4.Breastfeeding vs bottle feeding<\/p>\n
5.Socioeconomic status<\/p>\n
6.Pacifier use<\/p>\n
7.Obesity<\/li>\n<\/ul>\n
Classifications of Otitis Media<\/h4>\n\n- DURATION OF INFECTION<\/li>\n<\/ul>\n
1.ACUTE\u00a0 OM (6 WEEKS)<\/p>\n
2.CHRONIC OM (BEYOND 6WEEKS)<\/p>\n
3.(NB: VARIATIONS 2WKS , 4WKS)<\/p>\n
\n- NATURE OF FLUID OR DISCHARGE<\/li>\n<\/ul>\n
1.SUPPURATIVE OM<\/p>\n
2.NON-SUPPURATIVE OM<\/p>\n
3.OME<\/p>\n
4.AERO-OM<\/p>\n
\n- \n
\n- CAUSATIVE ORGANISM<\/li>\n<\/ul>\n
1.Bacterial OM eg S. Pneumoniae, H. Influenza, Moraxella catarrhalis<\/p>\n
2.Specific\u00a0 e.g. TB, SYPHILIS<\/p>\n
\n- MUCCOSAL CONDITION(BROWNINGS CLASSF)<\/li>\n<\/ul>\n
1.ACTIVE<\/p>\n
2.INACTIVE<\/p>\n
3.HEALED<\/li>\n<\/ul>\n
ACUTE OTITS MEDIA (AOM)<\/h4>\n\n- Predominantly a childhood infection<\/li>\n
- No sex preponderance<\/li>\n
- About 75% of cases are young adults < 44 yrs.<\/li>\n
- Aetiology:<\/li>\n<\/ul>\n
1.H. Influenza & S. Pneumonia globally predominates\u00a0 though Staph. aureus and S. pyogenes\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 predominate in African.<\/p>\n
Clinical features of AOM<\/h4>\n\n- SYSTEMIC(GENERALIZED)<\/li>\n<\/ul>\n
I.High grade fever (40-41 oC)<\/p>\n
II.Refusal of feeds<\/p>\n
III.Incessant cries & irritability<\/p>\n
\n- LOCAL(EAR)<\/li>\n<\/ul>\n
I.Otalgia<\/p>\n
II.Otorrhoea<\/p>\n
III.Tinnius<\/p>\n
IV.Conductive hearing loss<\/p>\n
V. Hyperemic tympanic membrane<\/p>\n
VI. Bulging TM or purulent discharge<\/p>\n
Sequalae of AOM<\/h4>\n\n- FULL RESOLUTION<\/li>\n
- COMPLICATIONS<\/li>\n<\/ul>\n
\n- EXTRACRANIAL<\/li>\n<\/ol>\n
I. Acute mastoiditis<\/p>\n
II. Subperiosteal abscess<\/p>\n
III. Facial nerve paralysis<\/p>\n
IV. Labyrinthitis<\/p>\n
\n- \n
\n- INTRACRANIAL<\/li>\n<\/ul>\n
I.Extradural abscesses<\/p>\n
II.Subdural abscesses<\/p>\n
III.Meningitis<\/p>\n
IV. Otitic brain abscess<\/p>\n
V. Otitic hydrocephaluus<\/p>\n
VI. Lateral sinus thrombosis<\/li>\n<\/ul>\n
Otitis media with effusion (OME)<\/h4>\n\n- Predominantly a childhood illness like AOM<\/li>\n
- About 85% of cases in children<\/li>\n
- Commoner among Caucasians, especially Canadians, Australians and American aborigines.<\/li>\n
- Predispositions include adenoid enlargement, Eustachian tube dysfunctions, Anatomic congenital defects especially clefts.<\/li>\n
- NPC and rhinosinusitis in adults.<\/li>\n<\/ul>\n
Clinical features of OME<\/h4>\n\n- Conductive Hearing loss(CHL)<\/li>\n
- Mild to moderate CHL (<40dB)<\/li>\n
- Prevalent in age <5years<\/li>\n
- Otalgia<\/li>\n
- Sometimes incidentally found in routine hearing screening.<\/li>\n
- Speech difficulties<\/li>\n
- Shows type B tympanometry<\/li>\n
- Bulgy and immobile tympanic membrane<\/li>\n
- Loss of light reflexes on tympanic membrane<\/li>\n
- Pneumatic otoscope useful for diagnosis<\/li>\n
- Tympanometry is gold standard for diagnosis<\/li>\n
- TM may show air bubbles<\/li>\n
- Effusion usually serous<\/li>\n
- Can organize into glue ear<\/li>\n<\/ul>\n
Sequalae of OME<\/h4>\n\n- Mainly resolves spontaneously<\/li>\n
- Failure to resolve in 6wks can give rise to glue ear<\/li>\n
- Ossicular bone erosion<\/li>\n<\/ul>\n
Chronic Otitis Media (COM)<\/h4>\n\n- Permanent abnormality on the tympanic membrane following a long standing middle ear infection emanating from previous AOM, OME or negative pressure of middle ear.<\/li>\n
- <\/li>\n
- Duration suggested from 2weeks -3months.<\/li>\n
- Prevalence (6-11.1%) high in developing countries<\/li>\n
- Preponderant in adults<\/li>\n<\/ul>\n
CSOM<\/h4>\n\n- Chronic suppurative & chronic non-suppurative OM.<\/li>\n
- Tubotympanic & Attico antral (so called Safe and unsafe OM) considering chances of cholesteatoma formation.<\/li>\n
- Most recent classification<\/li>\n<\/ul>\n
A. Mucossal or squamous<\/p>\n
\n- \u00a0Active,<\/li>\n
- Inactive or<\/li>\n
- healed.<\/li>\n<\/ol>\n
\n- \n
\n- AETIOLOGY<\/li>\n
- Common aerobes are:<\/li>\n<\/ul>\n
I.Pseudomonas aeuroginosa<\/p>\n
II.Proteus spp<\/p>\n
III.Esschericha coli<\/p>\n
IV.Staph aureus<\/p>\n
\n- Common Anaerobes<\/li>\n<\/ul>\n
A.Peptostreptococcus,<\/p>\n
\n- Prevotel<\/li>\n<\/ol>\n
2.B. fragilis<\/li>\n<\/ul>\n
Clinical features of OME<\/h4>\n\n- Mixed hearing loss<\/li>\n
- Sensorineural hearing loss<\/li>\n
- Otorrhoea (usually Scanty foul smelling)<\/li>\n
- Neo membrane formation<\/li>\n
- Aural polyp<\/li>\n<\/ul>\n
Complications of CSOM<\/h4>\n
![\"\"](\"https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2024\/04\/Picture6.png?resize=300%2C165&ssl=1\")
<\/p>\n
Extratemporal<\/p>\n
1.Lucs abscess—temporalis region<\/p>\n
2.Citelli——-subperiosteal abscess<\/p>\n
3.Bezolds abscess———-Sternocleidomastoid.<\/p>\n
Illustrations<\/p>\n
![\"\"](\"https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2024\/04\/Picture7.png?resize=300%2C143&ssl=1\")
<\/p>\n
<\/p>\n
Investigations<\/h2>\n\n- M\/C\/S<\/li>\n
- Imaging<\/li>\n
- X-ray mastoid<\/li>\n
- Cranial & Brain CT Scan<\/li>\n
- Audiogram-Pure Tone Audiogram Tympanometry<\/li>\n
- FBC<\/li>\n<\/ul>\n
<\/p>\n
Treatment<\/h2>\n
1.Medical<\/p>\n
2.Surgical<\/p>\n
<\/p>\n
Prevention<\/h2>\n\n- Mainly Environmental Factor Mgt<\/li>\n
- Vaccines-<\/li>\n<\/ul>\n
i.Bacterial S. Pneumoniae(Prevenar CV5, PCV7 & PCV-13).<\/p>\n
ii.Maternal immunization-H. influenza, M cattarhalis Vaccines.<\/p>\n
iii.VIRAL<\/p>\n
iv.Inflenza<\/p>\n
v.Resp. Cynct Virus vaccine<\/p>\n
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–<\/p>\n","protected":false},"excerpt":{"rendered":"
OTITIS EXTERNA and OTITIS MEDIA BY DR BULUS N G…<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-455","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\n
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<\/p>\n
INTRODUCTION<\/h2>\n\n- The ear is the organ of the body used for hearing and balancing.<\/li>\n
- Divided into three; the outer or external ear, middle ear and inner ear.<\/li>\n
- The outer and middle ear are responsible for conduction of sound impulses to the inner ear<\/li>\n
- The outer and middle ear are prone to exposure to various injurious agents.<\/li>\n
- This can result to inflammation of the outer or inner ear<\/li>\n
- Otitis Externa <\/b>is simply the inflammation of the outer opening of the ear and the ear canal.<\/li>\n
- Also referred to as the swimmers ear.<\/li>\n
- Otitis Media <\/b>Is the inflammation of the mucous membranes of the middle ear cavity (Eustachian tube, mastoid antrum, mastoid air cells and tympanic cavity).<\/li>\n
- Some causative organisms includes;1.Acute Bacterial Infection\n
2.Fungal Infection<\/p>\n
3.Acute Viral<\/p>\n
4.Associated with Allergy<\/li>\n<\/ul>\n
Primary functions of Ext Ear<\/p>\n
<\/p>\n
<\/p>\n
<\/h2>\n<\/h2>\nOTITIS EXTERNA\u00a0\u00a0<\/b><\/h2>\n
CLINICAL FEATURES OF OTITIS EXTERNA<\/p>\n
\n- Pain<\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0Aggravated at night<\/li>\n
- \u00a0 \u00a0 \u00a0Worsened by contact with pinna<\/li>\n<\/ol>\n
\n- Swelling<\/li>\n
- Otorrhoea (non-mucoid)<\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0 Purulent<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 Watery<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0Desquamated tissues<\/li>\n<\/ol>\n
\n- Itching<\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0Otomycosis<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0Allergy<\/li>\n<\/ol>\n
\n- Tinnitus<\/li>\n
- Hearing loss- otorrhoea, stenosis & canal plug<\/li>\n
- Trismus \u2013when anterior canal wall \/TMJ are involved<\/li>\n
- Tragal tenderness<\/li>\n<\/ul>\n
<\/p>\n
BACTERIAL OTITIS EXTERNA<\/h2>\n\n- Common aetiology- Pseudomonas, Staph spp, Strep spp, gram negative rods spp<\/i><\/li>\n
- Localised e.g. Furunculosis<\/i><\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Hair root infections. <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0usually from staph. aureus<\/i><\/li>\n<\/ol>\n
\n- Generalised e.g. <\/i>Erisipelas<\/i><\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Acute streptococcal lymphangitis and dermatitis with propensity for\u00a0 rapid spread .<\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0commonly\u00a0 triggered by scratching.<\/i><\/li>\n<\/ol>\n
\n- +\/- purulent discharge<\/i><\/li>\n<\/ul>\n
Illustrations<\/p>\n
<\/p>\n
<\/p>\n
FUNGAL OTITIS EXTERNA (OTOMYCOSIS)<\/h2>\n\n- Fungal infections of the ear(external)<\/li>\n
- Common agents<\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i>– nigra <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i> fumigatus\u00a0 <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i> flavus<\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Candida albicans<\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Yeast spp<\/i><\/li>\n<\/ol>\n
<\/p>\n
CLINICAL FEATURES OF OTOMYCOSIS<\/h2>\n\n- Invades the deeper layers of the skin unlike the bacterial OE.<\/li>\n
- Aggravated by moisture and humidity<\/li>\n
- Very itchy<\/li>\n
- Black, brown or dirty-white discharge<\/li>\n
- Cotton-like growth<\/li>\n
- Spores formation<\/li>\n
- Resistant and requires prolonged therapy<\/li>\n
- Tinnitus<\/li>\n
- Hearing loss<\/li>\n
- Exuberant and florid features in the immuno-compromised.<\/li>\n<\/ul>\n
<\/p>\n
VIRAL OTITIS EXTERNA<\/h2>\n\n- This is not as prevalent as bacterial or fungal.<\/li>\n
- Herpes simplex (H. simplex virus 1)<\/li>\n<\/ul>\n
\n- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0characterised by inflammed mucosa<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Assoc with clear fluid discharge.<\/li>\n<\/ol>\n
\n- Herpes zoster(Varicella varice)<\/li>\n<\/ul>\n
\n- Assoc with vesicular eruption within EAC<\/li>\n
- Paralysis of VII & other CNs may result (Ramsay \u2013Hunt syndrome).<\/li>\n<\/ol>\n
\n- Bullous myringitis causative org,<\/li>\n<\/ul>\n
\n- May be associated with influenza<\/li>\n
- Haemorrhagic vesicles on external\u00a0 surface of TM<\/li>\n<\/ol>\n
Illustrations<\/p>\n
<\/p>\n
<\/p>\n
ATOPIC (ECZEMATOUS) & SEBORRHOEIC OTITIS EXTERNA<\/h2>\n\n- OE associated with atopy or allergic conditions.<\/li>\n
- Basically an allergic dermatitis\/irritation of the skin of the EAC.<\/li>\n
- May be similar to the seborrheic scalp infections .<\/li>\n<\/ul>\n
<\/p>\n
Features of Atopic Otitis Externa<\/h3>\n\n- Irritation<\/li>\n
- Scaling<\/li>\n
- Swelling<\/li>\n
- Weeping of the EAC skin<\/li>\n
- Secondary infections<\/li>\n<\/ul>\n
Illustrations<\/p>\n
<\/p>\n
<\/p>\n
Investigations<\/h3>\n
I. Clinical findings key<\/p>\n
II. Microscopy culture and sensitivity<\/p>\n
III. Imaging<\/p>\n
\n- X-ray mastoid<\/li>\n
- CT scan<\/li>\n<\/ol>\n
IV. Pure Tone Audiogram<\/p>\n
Treatment<\/h3>\n\n- TOPICAL<\/li>\n<\/ul>\n
\n- Aural toileting<\/li>\n
- Keep ears dry<\/li>\n
- Topical antibiotics<\/li>\n
- Topical anti-inflammatory +\/- steroid<\/li>\n<\/ol>\n
\n- SYSTEMIC<\/li>\n<\/ul>\n
\n- Antibiotics<\/li>\n
- Analgesic<\/li>\n
- Antipruritic agents<\/li>\n<\/ol>\n
Differentials<\/h3>\n\n- Otitis externa maligna<\/li>\n
- Myringitis<\/li>\n
- Wax<\/li>\n
- Foreign bodies<\/li>\n
- Keratosis Obturans<\/li>\n
- Exostosis<\/li>\n
- Otitis media<\/li>\n
- Neoplasm<\/li>\n<\/ul>\n
<\/p>\n
<\/p>\n
OTITIS MEDIA<\/h2>\n
<\/p>\n
Definition<\/h4>\n\n- Otitis media is simply inflammation or infection of the middle ear.<\/li>\n
- The mucosa of the middle ear cleft is the point of infection.<\/li>\n
- It is a global ear disease with health-economic burden.<\/li>\n
- Most prevalent(up to 11%) in Africa and developing world.<\/li>\n<\/ul>\n
CLINICAL FEATURES OF OTITIS MEDIA<\/h4>\n\n- Presents with varied clinical features depending on the duration, severity and progression of disease.<\/li>\n
- <\/li>\n
- Due to the complex contiguous relationship between middle ear and essential intracranial structures , complications could be bizarre.<\/li>\n
- Intra cranial and extra cranial sequelae results from untreated or poorly treated OM<\/li>\n
- The acute phase can get resolved<\/li>\n
- May progress to chronicity with attendant complications<\/li>\n
- Good Knowledge of Anatomy of middle ear is necessary for attendant physicians.<\/li>\n<\/ul>\n
Predisposing Factors<\/h4>\n\n- HOST-RELATED<\/b><\/li>\n<\/ul>\n
1.Age-highest incidence 6-11 months<\/p>\n
2.Sex \u2013nil preponderance<\/p>\n
3.Race \u2013inconclusive<\/p>\n
4.Prematurity \u2013 lowbirthweight(+ve)<\/p>\n
5.Allergy- (+ve)controversy in pathogenesis<\/p>\n
6.Immunocompetency<\/p>\n
7.Cleftplate\/craniofacial abromalities(+ve)<\/p>\n
8.Genetic predispo-(+ve)<\/p>\n
\n- \n
\n- ENVIRONMENTAL FACTORS<\/b><\/li>\n<\/ul>\n
1.URTI\/Seasonal<\/p>\n
2.Day care\/Home care\/sibs<\/p>\n
3.Tobacco smoke exposure<\/p>\n
4.Breastfeeding vs bottle feeding<\/p>\n
5.Socioeconomic status<\/p>\n
6.Pacifier use<\/p>\n
7.Obesity<\/li>\n<\/ul>\n
Classifications of Otitis Media<\/h4>\n\n- DURATION OF INFECTION<\/li>\n<\/ul>\n
1.ACUTE\u00a0 OM (6 WEEKS)<\/p>\n
2.CHRONIC OM (BEYOND 6WEEKS)<\/p>\n
3.(NB: VARIATIONS 2WKS , 4WKS)<\/p>\n
\n- NATURE OF FLUID OR DISCHARGE<\/li>\n<\/ul>\n
1.SUPPURATIVE OM<\/p>\n
2.NON-SUPPURATIVE OM<\/p>\n
3.OME<\/p>\n
4.AERO-OM<\/p>\n
\n- \n
\n- CAUSATIVE ORGANISM<\/li>\n<\/ul>\n
1.Bacterial OM eg S. Pneumoniae, H. Influenza, Moraxella catarrhalis<\/p>\n
2.Specific\u00a0 e.g. TB, SYPHILIS<\/p>\n
\n- MUCCOSAL CONDITION(BROWNINGS CLASSF)<\/li>\n<\/ul>\n
1.ACTIVE<\/p>\n
2.INACTIVE<\/p>\n
3.HEALED<\/li>\n<\/ul>\n
ACUTE OTITS MEDIA (AOM)<\/h4>\n\n- Predominantly a childhood infection<\/li>\n
- No sex preponderance<\/li>\n
- About 75% of cases are young adults < 44 yrs.<\/li>\n
- Aetiology:<\/li>\n<\/ul>\n
1.H. Influenza & S. Pneumonia globally predominates\u00a0 though Staph. aureus and S. pyogenes\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 predominate in African.<\/p>\n
Clinical features of AOM<\/h4>\n\n- SYSTEMIC(GENERALIZED)<\/li>\n<\/ul>\n
I.High grade fever (40-41 oC)<\/p>\n
II.Refusal of feeds<\/p>\n
III.Incessant cries & irritability<\/p>\n
\n- LOCAL(EAR)<\/li>\n<\/ul>\n
I.Otalgia<\/p>\n
II.Otorrhoea<\/p>\n
III.Tinnius<\/p>\n
IV.Conductive hearing loss<\/p>\n
V. Hyperemic tympanic membrane<\/p>\n
VI. Bulging TM or purulent discharge<\/p>\n
Sequalae of AOM<\/h4>\n\n- FULL RESOLUTION<\/li>\n
- COMPLICATIONS<\/li>\n<\/ul>\n
\n- EXTRACRANIAL<\/li>\n<\/ol>\n
I. Acute mastoiditis<\/p>\n
II. Subperiosteal abscess<\/p>\n
III. Facial nerve paralysis<\/p>\n
IV. Labyrinthitis<\/p>\n
\n- \n
\n- INTRACRANIAL<\/li>\n<\/ul>\n
I.Extradural abscesses<\/p>\n
II.Subdural abscesses<\/p>\n
III.Meningitis<\/p>\n
IV. Otitic brain abscess<\/p>\n
V. Otitic hydrocephaluus<\/p>\n
VI. Lateral sinus thrombosis<\/li>\n<\/ul>\n
Otitis media with effusion (OME)<\/h4>\n\n- Predominantly a childhood illness like AOM<\/li>\n
- About 85% of cases in children<\/li>\n
- Commoner among Caucasians, especially Canadians, Australians and American aborigines.<\/li>\n
- Predispositions include adenoid enlargement, Eustachian tube dysfunctions, Anatomic congenital defects especially clefts.<\/li>\n
- NPC and rhinosinusitis in adults.<\/li>\n<\/ul>\n
Clinical features of OME<\/h4>\n\n- Conductive Hearing loss(CHL)<\/li>\n
- Mild to moderate CHL (<40dB)<\/li>\n
- Prevalent in age <5years<\/li>\n
- Otalgia<\/li>\n
- Sometimes incidentally found in routine hearing screening.<\/li>\n
- Speech difficulties<\/li>\n
- Shows type B tympanometry<\/li>\n
- Bulgy and immobile tympanic membrane<\/li>\n
- Loss of light reflexes on tympanic membrane<\/li>\n
- Pneumatic otoscope useful for diagnosis<\/li>\n
- Tympanometry is gold standard for diagnosis<\/li>\n
- TM may show air bubbles<\/li>\n
- Effusion usually serous<\/li>\n
- Can organize into glue ear<\/li>\n<\/ul>\n
Sequalae of OME<\/h4>\n\n- Mainly resolves spontaneously<\/li>\n
- Failure to resolve in 6wks can give rise to glue ear<\/li>\n
- Ossicular bone erosion<\/li>\n<\/ul>\n
Chronic Otitis Media (COM)<\/h4>\n\n- Permanent abnormality on the tympanic membrane following a long standing middle ear infection emanating from previous AOM, OME or negative pressure of middle ear.<\/li>\n
- <\/li>\n
- Duration suggested from 2weeks -3months.<\/li>\n
- Prevalence (6-11.1%) high in developing countries<\/li>\n
- Preponderant in adults<\/li>\n<\/ul>\n
CSOM<\/h4>\n\n- Chronic suppurative & chronic non-suppurative OM.<\/li>\n
- Tubotympanic & Attico antral (so called Safe and unsafe OM) considering chances of cholesteatoma formation.<\/li>\n
- Most recent classification<\/li>\n<\/ul>\n
A. Mucossal or squamous<\/p>\n
\n- \u00a0Active,<\/li>\n
- Inactive or<\/li>\n
- healed.<\/li>\n<\/ol>\n
\n- \n
\n- AETIOLOGY<\/li>\n
- Common aerobes are:<\/li>\n<\/ul>\n
I.Pseudomonas aeuroginosa<\/p>\n
II.Proteus spp<\/p>\n
III.Esschericha coli<\/p>\n
IV.Staph aureus<\/p>\n
\n- Common Anaerobes<\/li>\n<\/ul>\n
A.Peptostreptococcus,<\/p>\n
\n- Prevotel<\/li>\n<\/ol>\n
2.B. fragilis<\/li>\n<\/ul>\n
Clinical features of OME<\/h4>\n\n- Mixed hearing loss<\/li>\n
- Sensorineural hearing loss<\/li>\n
- Otorrhoea (usually Scanty foul smelling)<\/li>\n
- Neo membrane formation<\/li>\n
- Aural polyp<\/li>\n<\/ul>\n
Complications of CSOM<\/h4>\n
<\/p>\n
Extratemporal<\/p>\n
1.Lucs abscess—temporalis region<\/p>\n
2.Citelli——-subperiosteal abscess<\/p>\n
3.Bezolds abscess———-Sternocleidomastoid.<\/p>\n
Illustrations<\/p>\n
<\/p>\n
<\/p>\n
Investigations<\/h2>\n\n- M\/C\/S<\/li>\n
- Imaging<\/li>\n
- X-ray mastoid<\/li>\n
- Cranial & Brain CT Scan<\/li>\n
- Audiogram-Pure Tone Audiogram Tympanometry<\/li>\n
- FBC<\/li>\n<\/ul>\n
<\/p>\n
Treatment<\/h2>\n
1.Medical<\/p>\n
2.Surgical<\/p>\n
<\/p>\n
Prevention<\/h2>\n\n- Mainly Environmental Factor Mgt<\/li>\n
- Vaccines-<\/li>\n<\/ul>\n
i.Bacterial S. Pneumoniae(Prevenar CV5, PCV7 & PCV-13).<\/p>\n
ii.Maternal immunization-H. influenza, M cattarhalis Vaccines.<\/p>\n
iii.VIRAL<\/p>\n
iv.Inflenza<\/p>\n
v.Resp. Cynct Virus vaccine<\/p>\n
<\/p>\n
<\/h2>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
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<\/p>\n
–<\/p>\n","protected":false},"excerpt":{"rendered":"
OTITIS EXTERNA and OTITIS MEDIA BY DR BULUS N G…<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-455","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\n
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2.Fungal Infection<\/p>\n
3.Acute Viral<\/p>\n
4.Associated with Allergy<\/li>\n<\/ul>\n
Primary functions of Ext Ear<\/p>\n
<\/p>\n
<\/p>\n
<\/h2>\n<\/h2>\nOTITIS EXTERNA\u00a0\u00a0<\/b><\/h2>\n
OTITIS EXTERNA\u00a0\u00a0<\/b><\/h2>\n
CLINICAL FEATURES OF OTITIS EXTERNA<\/p>\n
- \n
- Pain<\/li>\n<\/ul>\n
- \n
- \u00a0 \u00a0 \u00a0Aggravated at night<\/li>\n
- \u00a0 \u00a0 \u00a0Worsened by contact with pinna<\/li>\n<\/ol>\n
- \n
- Swelling<\/li>\n
- Otorrhoea (non-mucoid)<\/li>\n<\/ul>\n
- \n
- \u00a0 \u00a0 \u00a0 \u00a0 Purulent<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 Watery<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0Desquamated tissues<\/li>\n<\/ol>\n
- \n
- Itching<\/li>\n<\/ul>\n
- \n
- \u00a0 \u00a0 \u00a0 \u00a0Otomycosis<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0Allergy<\/li>\n<\/ol>\n
- \n
- Tinnitus<\/li>\n
- Hearing loss- otorrhoea, stenosis & canal plug<\/li>\n
- Trismus \u2013when anterior canal wall \/TMJ are involved<\/li>\n
- Tragal tenderness<\/li>\n<\/ul>\n
<\/p>\n
BACTERIAL OTITIS EXTERNA<\/h2>\n
- \n
- Common aetiology- Pseudomonas, Staph spp, Strep spp, gram negative rods spp<\/i><\/li>\n
- Localised e.g. Furunculosis<\/i><\/li>\n<\/ul>\n
- \n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Hair root infections. <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0usually from staph. aureus<\/i><\/li>\n<\/ol>\n
- \n
- Generalised e.g. <\/i>Erisipelas<\/i><\/li>\n<\/ul>\n
- \n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Acute streptococcal lymphangitis and dermatitis with propensity for\u00a0 rapid spread .<\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0commonly\u00a0 triggered by scratching.<\/i><\/li>\n<\/ol>\n
- \n
- +\/- purulent discharge<\/i><\/li>\n<\/ul>\n
Illustrations<\/p>\n
<\/p>\n<\/p>\n
FUNGAL OTITIS EXTERNA (OTOMYCOSIS)<\/h2>\n
- \n
- Fungal infections of the ear(external)<\/li>\n
- Common agents<\/li>\n<\/ul>\n
- \n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i>– nigra <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i> fumigatus\u00a0 <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i> flavus<\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Candida albicans<\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Yeast spp<\/i><\/li>\n<\/ol>\n
<\/p>\n
CLINICAL FEATURES OF OTOMYCOSIS<\/h2>\n
- \n
- Invades the deeper layers of the skin unlike the bacterial OE.<\/li>\n
- Aggravated by moisture and humidity<\/li>\n
- Very itchy<\/li>\n
- Black, brown or dirty-white discharge<\/li>\n
- Cotton-like growth<\/li>\n
- Spores formation<\/li>\n
- Resistant and requires prolonged therapy<\/li>\n
- Tinnitus<\/li>\n
- Hearing loss<\/li>\n
- Exuberant and florid features in the immuno-compromised.<\/li>\n<\/ul>\n
<\/p>\n
VIRAL OTITIS EXTERNA<\/h2>\n
- \n
- This is not as prevalent as bacterial or fungal.<\/li>\n
- Herpes simplex (H. simplex virus 1)<\/li>\n<\/ul>\n
- \n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0characterised by inflammed mucosa<\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Assoc with clear fluid discharge.<\/li>\n<\/ol>\n
- \n
- Herpes zoster(Varicella varice)<\/li>\n<\/ul>\n
- \n
- Assoc with vesicular eruption within EAC<\/li>\n
- Paralysis of VII & other CNs may result (Ramsay \u2013Hunt syndrome).<\/li>\n<\/ol>\n
- \n
- Bullous myringitis causative org,<\/li>\n<\/ul>\n
- \n
- May be associated with influenza<\/li>\n
- Haemorrhagic vesicles on external\u00a0 surface of TM<\/li>\n<\/ol>\n
Illustrations<\/p>\n
<\/p>\n<\/p>\n
ATOPIC (ECZEMATOUS) & SEBORRHOEIC OTITIS EXTERNA<\/h2>\n
- \n
- OE associated with atopy or allergic conditions.<\/li>\n
- Basically an allergic dermatitis\/irritation of the skin of the EAC.<\/li>\n
- May be similar to the seborrheic scalp infections .<\/li>\n<\/ul>\n
<\/p>\n
Features of Atopic Otitis Externa<\/h3>\n
- \n
- Irritation<\/li>\n
- Scaling<\/li>\n
- Swelling<\/li>\n
- Weeping of the EAC skin<\/li>\n
- Secondary infections<\/li>\n<\/ul>\n
Illustrations<\/p>\n
<\/p>\n<\/p>\n
Investigations<\/h3>\n
I. Clinical findings key<\/p>\n
II. Microscopy culture and sensitivity<\/p>\n
III. Imaging<\/p>\n
- \n
- X-ray mastoid<\/li>\n
- CT scan<\/li>\n<\/ol>\n
IV. Pure Tone Audiogram<\/p>\n
Treatment<\/h3>\n
- \n
- TOPICAL<\/li>\n<\/ul>\n
- \n
- Aural toileting<\/li>\n
- Keep ears dry<\/li>\n
- Topical antibiotics<\/li>\n
- Topical anti-inflammatory +\/- steroid<\/li>\n<\/ol>\n
- \n
- SYSTEMIC<\/li>\n<\/ul>\n
- \n
- Antibiotics<\/li>\n
- Analgesic<\/li>\n
- Antipruritic agents<\/li>\n<\/ol>\n
Differentials<\/h3>\n
- \n
- Otitis externa maligna<\/li>\n
- Myringitis<\/li>\n
- Wax<\/li>\n
- Foreign bodies<\/li>\n
- Keratosis Obturans<\/li>\n
- Exostosis<\/li>\n
- Otitis media<\/li>\n
- Neoplasm<\/li>\n<\/ul>\n
<\/p>\n
<\/p>\n
OTITIS MEDIA<\/h2>\n
<\/p>\nDefinition<\/h4>\n
- \n
- Otitis media is simply inflammation or infection of the middle ear.<\/li>\n
- The mucosa of the middle ear cleft is the point of infection.<\/li>\n
- It is a global ear disease with health-economic burden.<\/li>\n
- Most prevalent(up to 11%) in Africa and developing world.<\/li>\n<\/ul>\n
CLINICAL FEATURES OF OTITIS MEDIA<\/h4>\n
- \n
- Presents with varied clinical features depending on the duration, severity and progression of disease.<\/li>\n
- <\/li>\n
- Due to the complex contiguous relationship between middle ear and essential intracranial structures , complications could be bizarre.<\/li>\n
- Intra cranial and extra cranial sequelae results from untreated or poorly treated OM<\/li>\n
- The acute phase can get resolved<\/li>\n
- May progress to chronicity with attendant complications<\/li>\n
- Good Knowledge of Anatomy of middle ear is necessary for attendant physicians.<\/li>\n<\/ul>\n
Predisposing Factors<\/h4>\n
- \n
- HOST-RELATED<\/b><\/li>\n<\/ul>\n
1.Age-highest incidence 6-11 months<\/p>\n
2.Sex \u2013nil preponderance<\/p>\n
3.Race \u2013inconclusive<\/p>\n
4.Prematurity \u2013 lowbirthweight(+ve)<\/p>\n
5.Allergy- (+ve)controversy in pathogenesis<\/p>\n
6.Immunocompetency<\/p>\n
7.Cleftplate\/craniofacial abromalities(+ve)<\/p>\n
8.Genetic predispo-(+ve)<\/p>\n
- \n
- \n
- \n
- ENVIRONMENTAL FACTORS<\/b><\/li>\n<\/ul>\n
1.URTI\/Seasonal<\/p>\n
2.Day care\/Home care\/sibs<\/p>\n
3.Tobacco smoke exposure<\/p>\n
4.Breastfeeding vs bottle feeding<\/p>\n
5.Socioeconomic status<\/p>\n
6.Pacifier use<\/p>\n
7.Obesity<\/li>\n<\/ul>\n
Classifications of Otitis Media<\/h4>\n
- \n
- DURATION OF INFECTION<\/li>\n<\/ul>\n
1.ACUTE\u00a0 OM (6 WEEKS)<\/p>\n
2.CHRONIC OM (BEYOND 6WEEKS)<\/p>\n
3.(NB: VARIATIONS 2WKS , 4WKS)<\/p>\n
- \n
- NATURE OF FLUID OR DISCHARGE<\/li>\n<\/ul>\n
1.SUPPURATIVE OM<\/p>\n
2.NON-SUPPURATIVE OM<\/p>\n
3.OME<\/p>\n
4.AERO-OM<\/p>\n
- \n
- \n
- \n
- CAUSATIVE ORGANISM<\/li>\n<\/ul>\n
1.Bacterial OM eg S. Pneumoniae, H. Influenza, Moraxella catarrhalis<\/p>\n
2.Specific\u00a0 e.g. TB, SYPHILIS<\/p>\n
- \n
- MUCCOSAL CONDITION(BROWNINGS CLASSF)<\/li>\n<\/ul>\n
1.ACTIVE<\/p>\n
2.INACTIVE<\/p>\n
3.HEALED<\/li>\n<\/ul>\n
ACUTE OTITS MEDIA (AOM)<\/h4>\n
- \n
- Predominantly a childhood infection<\/li>\n
- No sex preponderance<\/li>\n
- About 75% of cases are young adults < 44 yrs.<\/li>\n
- Aetiology:<\/li>\n<\/ul>\n
1.H. Influenza & S. Pneumonia globally predominates\u00a0 though Staph. aureus and S. pyogenes\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 predominate in African.<\/p>\n
Clinical features of AOM<\/h4>\n
- \n
- SYSTEMIC(GENERALIZED)<\/li>\n<\/ul>\n
I.High grade fever (40-41 oC)<\/p>\n
II.Refusal of feeds<\/p>\n
III.Incessant cries & irritability<\/p>\n
- \n
- LOCAL(EAR)<\/li>\n<\/ul>\n
I.Otalgia<\/p>\n
II.Otorrhoea<\/p>\n
III.Tinnius<\/p>\n
IV.Conductive hearing loss<\/p>\n
V. Hyperemic tympanic membrane<\/p>\n
VI. Bulging TM or purulent discharge<\/p>\n
Sequalae of AOM<\/h4>\n
- \n
- FULL RESOLUTION<\/li>\n
- COMPLICATIONS<\/li>\n<\/ul>\n
- \n
- EXTRACRANIAL<\/li>\n<\/ol>\n
I. Acute mastoiditis<\/p>\n
II. Subperiosteal abscess<\/p>\n
III. Facial nerve paralysis<\/p>\n
IV. Labyrinthitis<\/p>\n
- \n
- \n
- \n
- INTRACRANIAL<\/li>\n<\/ul>\n
I.Extradural abscesses<\/p>\n
II.Subdural abscesses<\/p>\n
III.Meningitis<\/p>\n
IV. Otitic brain abscess<\/p>\n
V. Otitic hydrocephaluus<\/p>\n
VI. Lateral sinus thrombosis<\/li>\n<\/ul>\n
Otitis media with effusion (OME)<\/h4>\n
- \n
- Predominantly a childhood illness like AOM<\/li>\n
- About 85% of cases in children<\/li>\n
- Commoner among Caucasians, especially Canadians, Australians and American aborigines.<\/li>\n
- Predispositions include adenoid enlargement, Eustachian tube dysfunctions, Anatomic congenital defects especially clefts.<\/li>\n
- NPC and rhinosinusitis in adults.<\/li>\n<\/ul>\n
Clinical features of OME<\/h4>\n
- \n
- Conductive Hearing loss(CHL)<\/li>\n
- Mild to moderate CHL (<40dB)<\/li>\n
- Prevalent in age <5years<\/li>\n
- Otalgia<\/li>\n
- Sometimes incidentally found in routine hearing screening.<\/li>\n
- Speech difficulties<\/li>\n
- Shows type B tympanometry<\/li>\n
- Bulgy and immobile tympanic membrane<\/li>\n
- Loss of light reflexes on tympanic membrane<\/li>\n
- Pneumatic otoscope useful for diagnosis<\/li>\n
- Tympanometry is gold standard for diagnosis<\/li>\n
- TM may show air bubbles<\/li>\n
- Effusion usually serous<\/li>\n
- Can organize into glue ear<\/li>\n<\/ul>\n
Sequalae of OME<\/h4>\n
- \n
- Mainly resolves spontaneously<\/li>\n
- Failure to resolve in 6wks can give rise to glue ear<\/li>\n
- Ossicular bone erosion<\/li>\n<\/ul>\n
Chronic Otitis Media (COM)<\/h4>\n
- \n
- Permanent abnormality on the tympanic membrane following a long standing middle ear infection emanating from previous AOM, OME or negative pressure of middle ear.<\/li>\n
- <\/li>\n
- Duration suggested from 2weeks -3months.<\/li>\n
- Prevalence (6-11.1%) high in developing countries<\/li>\n
- Preponderant in adults<\/li>\n<\/ul>\n
CSOM<\/h4>\n
- \n
- Chronic suppurative & chronic non-suppurative OM.<\/li>\n
- Tubotympanic & Attico antral (so called Safe and unsafe OM) considering chances of cholesteatoma formation.<\/li>\n
- Most recent classification<\/li>\n<\/ul>\n
A. Mucossal or squamous<\/p>\n
- \n
- \u00a0Active,<\/li>\n
- Inactive or<\/li>\n
- healed.<\/li>\n<\/ol>\n
- \n
- \n
- \n
- AETIOLOGY<\/li>\n
- Common aerobes are:<\/li>\n<\/ul>\n
I.Pseudomonas aeuroginosa<\/p>\n
II.Proteus spp<\/p>\n
III.Esschericha coli<\/p>\n
IV.Staph aureus<\/p>\n
- \n
- Common Anaerobes<\/li>\n<\/ul>\n
A.Peptostreptococcus,<\/p>\n
- \n
- Prevotel<\/li>\n<\/ol>\n
2.B. fragilis<\/li>\n<\/ul>\n
Clinical features of OME<\/h4>\n
- \n
- Mixed hearing loss<\/li>\n
- Sensorineural hearing loss<\/li>\n
- Otorrhoea (usually Scanty foul smelling)<\/li>\n
- Neo membrane formation<\/li>\n
- Aural polyp<\/li>\n<\/ul>\n
Complications of CSOM<\/h4>\n
<\/p>\nExtratemporal<\/p>\n
1.Lucs abscess—temporalis region<\/p>\n
2.Citelli——-subperiosteal abscess<\/p>\n
3.Bezolds abscess———-Sternocleidomastoid.<\/p>\n
Illustrations<\/p>\n
<\/p>\n<\/p>\n
Investigations<\/h2>\n
- \n
- M\/C\/S<\/li>\n
- Imaging<\/li>\n
- X-ray mastoid<\/li>\n
- Cranial & Brain CT Scan<\/li>\n
- Audiogram-Pure Tone Audiogram Tympanometry<\/li>\n
- FBC<\/li>\n<\/ul>\n
<\/p>\n
Treatment<\/h2>\n
1.Medical<\/p>\n
2.Surgical<\/p>\n
<\/p>\n
Prevention<\/h2>\n
- \n
- Mainly Environmental Factor Mgt<\/li>\n
- Vaccines-<\/li>\n<\/ul>\n
i.Bacterial S. Pneumoniae(Prevenar CV5, PCV7 & PCV-13).<\/p>\n
ii.Maternal immunization-H. influenza, M cattarhalis Vaccines.<\/p>\n
iii.VIRAL<\/p>\n
iv.Inflenza<\/p>\n
v.Resp. Cynct Virus vaccine<\/p>\n
<\/p>\n
<\/h2>\n
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–<\/p>\n","protected":false},"excerpt":{"rendered":"
OTITIS EXTERNA and OTITIS MEDIA BY DR BULUS N G…<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-455","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\n
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- Prevotel<\/li>\n<\/ol>\n
- Common Anaerobes<\/li>\n<\/ul>\n
- \n
- INTRACRANIAL<\/li>\n<\/ul>\n
- \n
- EXTRACRANIAL<\/li>\n<\/ol>\n
- LOCAL(EAR)<\/li>\n<\/ul>\n
- SYSTEMIC(GENERALIZED)<\/li>\n<\/ul>\n
- MUCCOSAL CONDITION(BROWNINGS CLASSF)<\/li>\n<\/ul>\n
- CAUSATIVE ORGANISM<\/li>\n<\/ul>\n
- \n
- NATURE OF FLUID OR DISCHARGE<\/li>\n<\/ul>\n
- DURATION OF INFECTION<\/li>\n<\/ul>\n
- ENVIRONMENTAL FACTORS<\/b><\/li>\n<\/ul>\n
- \n
- HOST-RELATED<\/b><\/li>\n<\/ul>\n
- SYSTEMIC<\/li>\n<\/ul>\n
- TOPICAL<\/li>\n<\/ul>\n
- Bullous myringitis causative org,<\/li>\n<\/ul>\n
- Herpes zoster(Varicella varice)<\/li>\n<\/ul>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i> fumigatus\u00a0 <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Aspergillius<\/i>– nigra <\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0commonly\u00a0 triggered by scratching.<\/i><\/li>\n<\/ol>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Acute streptococcal lymphangitis and dermatitis with propensity for\u00a0 rapid spread .<\/i><\/li>\n
- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0usually from staph. aureus<\/i><\/li>\n<\/ol>\n
- Localised e.g. Furunculosis<\/i><\/li>\n<\/ul>\n
- Common aetiology- Pseudomonas, Staph spp, Strep spp, gram negative rods spp<\/i><\/li>\n
- Itching<\/li>\n<\/ul>\n